MAJ. GEN. MERRiTTE W. IRELAND, M. C, CHIEF SURGEON, A. E. F., MAY 1, 1918,
TO OCTOBER 9, 1918
TShe
MEDICAL DEPARTMENT
OF THE UNITED STATES ARMY
IN THE WORLD WAR
VOLUME II
ADMINISTRATION
AMERICAN
EXPEDITIONARY
FORCES
PREPARED UNDER THE DIRECTION OF
MAJ. GEN. M. W. IRELAND
The Surgeon General
By
Colonel Joseph H. Ford, M. C.
UNITED STATES GOVERNMENT PRINTING OFFICE : 1927
■4
ADDITIONAL COPIES
OF TfflS PXTBLICA-nON MAT BE PROCtTRED FROM
THE SUPERINTENDENT OF DOCUMENTS
GOVERNMENT PRINTING OFFICE
WASHINGTON, D. 0.
AT
$3.40 PER COPY
LETTER OF TRANSMISSION
I have the honor to submit herewith a portion of the history of the
MEDICAL DEPARTMENT OF THE UNITED STATES ARMY IN THE
WORLD WAR. The portion submitted is Vokime II, and is entitled "AdMiN-
isTRATioN, American Expeditionary Forces."
M. W. Ireland,
Major General, the Surgeon General.
The Secretary of War.
3
Lieut. Col. Frank W. Weed, M. C, Editor in Chief
LoY McAfee, A. M., M. D., Assistant Editor in Chief
EDITORIAL BOARD"
Col. Bailey K. Ashford, M. C.
Col. Frank Billings, M. C.
Col. Thomas R. Boggs, M. C.
Col. George E. Brewer, M. C.
Col. W. P. Chamberlain, M. C.
Col. C. F. Craig, M. C.
Col. Haven Emerson, M. C.
Brig. Gen. John M. T. Finney, M. D.
Col. Joseph H. Ford, M. D.
Lieut. Col. Fielding H. Garrison, M. D.
Col. H. L. Gilchrist, M. C.
Brig. Gen. Jefferson R. Kean, M. D.
Lieut. Col. A. G. Love, M. C.
Col. Charles Lynch, M. C.
Col. James F. McKernon, M. C.
Col. R. T. Oliver, D. C.
Col. Charles R. Reynolds, M. C.
Col. Thomas W. Salmon, M. C.
Lieut. Col. G. E. de Schweinitz, M. C.
Col. J. F. SiLER, M. C.
Brig. Gen. W. S. Thayer, M. D.
Col. A. D. TUTTLE, M. C.
Col. William H. Welch, M. C.
Col. E. P. Wolfe, M. C.
Lieut. Col. Casey A. Wood, M. C.
Col. Hans Zinsser, M. C.
» The highest rank held during the World War has been used in the ease of each officer.
4
PREFACE
This volume considers only the more important administrative activities
of the Medical Department in the American Expeditionary Forces, for the
scope of these and their ramifications were such as to preclude, in the space
available, a more thorough discussion. On the other hand, since there is a
degree of overlapping of this and other volumes, for example. Volumes VI and
VIII, certain administrative matters already covered in these other volumes
are not taken up in detail herein. Thus the administrative matters which
related to the evacuation service of the Medical Department at the front are
considered in Volume VIII; the administrative matters closely connected with
sanitation will be found in Volume VI. The purely professional services,
though covered briefly in this volume, have been assigned greater space in
volumes appropriate to each subject. The fact that the service of but one
hospital center is discussed at some length, though such formations were
among the most important of the Medical Department enterprises, illustrates
the necessity for compressing the material available.
Certain subjects and activities may seemingly have been unduly slighted.
This has been due, on the one hand, to the necessity to avoid unnecessary
duplication, or, on the other hand, to the fact that official reports concerning
the subjects in question were too fragmentary. Thus, to the chief surgeon's
office, line of communications, the chief surgeon's office, American forces in
France, and the medical activities of some of the sections of the Services of
Supply it has been impossible to give the consideration which their importance
warrants.
Acknowledgment is made to Lieut. Frank Steiner, M. A. C, for arranging
the chapters on the brief histories of hospital centers, base, and camp hospitals.
» For the purpose of the history of the Medical Department of the United States Army in the World War, the period
of war activities extends from April 6, 1917, to December 31, 1919. In the professional volumes, however, in which are
recorded the medical and surgical aspects of the conflict, as applied to the actual care of the sick and wounded, this period is
extended, in some instances, to the time of the completion of the history of the given service. In this way only can the
results be followed to their logical conclusion.
TABLE OF CONTENTS
Page
Preface 5
Introduction I3
Section I. Organization and Administration of the Chief Surgeon's Office
Chapter I. General organization and development of the chief surgeon's office 39
II. Representation of the Medical Department on the general staff,
A. E. F 59
III. Liaison of the Medical Department, United States Army, with the med-
ical services of the Allies 71
IV. The administration division 85
V. The personnel division 89
VI. The dental section 105
VII. The nursing section; reconstruction aides 125
VIII. The division of sanitation and inspection 133
IX. The division of laboratories and infectious diseases ^ 137
X. The division of laboratories and infectious diseases continued — Central
Medical Department laboratorv 157
XI. The di vision of laboratories and infectious diseases continued — The sec-
tion of laboratories; technical work of laboratories 167
XII. The division of laboratories and infectious diseases continued — Section
of infectious diseases; section of wound bacteriology 203
XIII. The division of laboratories and infectious diseases continued — Section
of water supplies; section of food and nutrition; museum and art sec-
tion; laboratory of surgical research 213
XIV. The division of hospitalization 229
XV. The division of hospitaUzation continued — Hospital construction; pro-
curement 241
XVI. The di vision of hospitalization continued — Hospitalization of sick and
wounded 283
XVII. The division of hospitalization continued — Medical Department trans-
portation 317
XVIII. The division of hospitalization continued — The professional services 351
XIX. The finance and supply division 387
XX. The veterinary service 419
Section II. Medical Activities of Territorial Sections
Section III. Hospitals
Chapter XXI. Hospital centers ' 473
XXII. A typical hospital center 489
XXIII. Other hospital centers 537
XXIV. Base hospitals 629
XXV. Camp hospitals 749
Section IV. Evacuation of Patients to the United States; Discontinuance of
Hospitals
Chapter XXVI. Evacuation of patients to the United States 791
XXVII. Discontinuance of hospitals 807
7
8
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Section V. The Army of Occupation in Germany
Page
Chapter XXVIII. The American forces in Germany 813
XXIX. Department of sanitation and public health, German occupied
territory 821
Section VI. Medical Department Activities, American Forces in France
Appendix:
Report on organization, equipment, and functions of the Medical Department 835
Circulars promulgated by the chief surgeon, A. E. F 903
The more important memoranda promulgated by the division of laboratories and
infectious diseases, A. E. F 1057
The more important forms used in the laboratory service, A. E. F 1081
Index 1089
LIST OF TABLES
Table 1. Personnel, Medical Department, A. E. F., January 11, 1919 94
2. Personnel, Medical Department, A. E. F., July 12, 1919 96
3. Consolidated daily field report of Medical Department personnel, S. O. S.,
August 31, 1919 96
4. Types and numbers of laboratories in operation in the American Expedi-
tionary Forces, May, 1917, to April, 1919-. ■ 168
LIST OF PLATES
Frontispiece. Maj. Gen. M. W. Ireland, M. C, chief surgeon, A. E. F., May 1, 1918,
to October 9, 1918
Plate 1. Brig. Gen. Alfred E. Bradley, M. C, chief surgeon, A. E. F., to April 30, 1918. 40
2. Brig. Gen. Walter D. McCaw, M. C, chief surgeon, A. E. F., October 10,
1918, to July 15, 1919 41
LIST OF CHARTS
Chart I. Showing organization of chief surgeon's office, A. E. F., March 6, 1918 51
II. Scheme for organization of Medical Department, A. E. F., corrected to
November 11, 1918 55
III. Scheme for organization of division of sanitation and inspection, chief
surgeon's office, A. E. F 133
LIST OF FIGURES
Figure
1. Lines of communication, A. E. F., showing also the sections comprising the
Services of Supply Facing 31
2. Wing B, of group of three main buildings, general headquarters, A. E. F., in
which the office of the chief surgeon, A. E. F., was located prior to its removal
to Tours. This wing also was the location, subsequently, of the medical
group, G-4, general staff, A. E. F 4q
3. Headquarters, Services of Supply, A. E. F., at Tours. The chief surgeon's
office occupied practically the entire first floor of the wing on the right 53
4. Building in Tours in which the finance and accounting division of the chief
surgeon's office was located
5. Ground plan, headquarters, division of laboratories, A. E. F., and Central
Medical Department Laboratory, Dijon
6. Floor plan of the office of the director, division of laboratories, A. E. F . 148
7. Central Medical Department Laboratory, Dijon. The main building is in the
center of the background ^g-,
8. Diagram showing types of laboratories in the American Expeditionary Forces]] 168
9. Pathological room in the laboratory, Vichy hospital center ~ i7fi
TABLE OF CONTENTS 9
Page
10. Bacteriological laboratorj^ Vichy hospital center 178
11. Field laboratory car 183
12. Front of interior of field laboratory car 184
13. Rear of interior of field laboratory car 185
14. Interior of field laboratory car, showing water still, autoclave, and sterilizers 186
15. Transportable laboratory in eight chests 188
16 to 19. Chests of transportable laboratory opened to show contents 189-192
20. Showing preparations for shipping portable laboratories from the Central Medical
Department Laboratory, Dijon 193
21. General layout of hospital unit, type A (base hospital) with wards 20 feet wide.
Demountable buildings 242
22. General layout of hospital unit, type A, with wards 20 feet wide. Permanent
buildings 243
23. General layout of hospital unit, type A, with wards 36 feet wide 244
24. Ward building (20 feet wide), hospital unit, type A. Demountable 245
25. Ward building (36 feet wide), hospital unit, type A 245
26. Administration building, hospital unit, type A 245
27. Nurses' quarters, hospital unit, type A 246
28. Nurses' dining room and kitchen, hospital unit, type A; for use with demountable
buildings 246
29. Officers' quarters and dining room, hospital unit, type A; for use with demount-
able buildings 247
30. Officers ' quarters, hospital unit, type A; for use with permanent type of buildings. 248
31. Receiving and evacuating hall, hospital unit, type A; for use with demountable
buildings 249
32. Receiving and evacuating hall and patients' bath, hospital vmit, type A. Perma-
nent type 249
33. Patients' bath, hospital unit, type A, for use with demountable buildings 249
34. Recreation hall, hospital unit, type A; permanent building type 250
35. Nurses recreation club, hospital unit, type A; demountable 251
36. Laboratory and morgue, hospital unit, type A; demountable 251
37. Operating and X-ray building, hospital unit, type A; demountable 252
38. Operating, X-ray, and clinic building, hospital unit, type A 253
39. Dispensary and clinic building, hospital unit, type A; demountable 254
40. Clinic and surgical dressings building, hospital unit, type A 254
41. Patients' kitchen, hospital unit, type A; temporary type 254
42. Patients' kitchen and dining halls, hospital unit, type A; permanent type 255
43. Patients' dining hall, hospital unit, type A, for use only when demountable
buildings were furnished 256
44. Quartermaster's storehouse, hospital unit, type A; demountable 256
45. Quartermaster's and medical storehouse, hospital unit, type A; permanent 257
46. Barrack building, hospital unit, type A; demountable 258
47. Personnel dining hall, hospital unit, type A; demountable 258
48. Medical storehouse, hospital unit, type A; demountable 259
49. Disinfector building, hospital unit, type A; demountable 260
50. Ablution building, hospital unit, type A; demountable 260
51. General layout, hospital center, Bazoilles 261
52. General layout, hospital center. Mars 262
53. General layout, hospital unit, type B (camp hospital) 263
54. Ward, hospital unit, type B 264
55. Administration building and officers' quarters, hospital unit, type B 264
56. Patients' mess, hospital unit, type B 265
57. Bath and disinfector, hospital unit, type B 265
58. Operating and clinic building, hospital unit, type B 266
59. General layout, hospital unit, type C (convalescent camp), 2,000 beds 267
60. Administration and clinic building, hospital unit, type C 268
10 AD]\riNISTRATION, AMERICAN EXPEDITIONARY FORCES
Page
61. Officers' quarters and mess hall, hospital unit, type C
62. Standard barrack, hospital unit, type C
63. Kitchen, hospital unit, type C
64. Quartermaster building, hospital unit, type C
65. Shops and disinfector building, hospital unit, type C 272
66. Laundry building, hospital unit, type C
67. Dining hall, hospital unit, type C
68. Bathhouse, hospital unit, type C ^''^
69. Venereal and skin clinic, hospital unit, type C — 274
70. Perspective of a Bessonneau tent in a two-tent unit 275
71. Perspective of a Bessonneau tent, showing framing and double walls 275
72. Plan of a two-tent (Bessonneau) ward 275
73. Showing heating arrangements in a Bessonneau tent 276
74. Perspective of a marquee tent ward, showing a unit of three tents 277
75. Plan of a marquee tent ward of three tents 278
76. Showing heating arrangements in a marquee tent ward 278
77. Perspective of closet in a marquee tent, showing construction 279
78. Plan of a two-tent ward, United States hospital ward tent 279
79. Outhne map of France showing the location of the various fixed hospitals of the
American Expeditionary Forces Facing 288
80. American Red Cross Military Hospital No. 21, Paignton, Devon, England 289
81. American Red Cross Convalescent Hospital No. 101, Lingfield, Surrey, England
(for officers) 290
82. Hospital train obtained from the French, at Base Hospital No. 9, Chateauroux. _ 321
83. French hospital train, with continental type of carriage 322
84. Interior of one of our hospital trains (British built) 328
85. Hospital train at Base Hospital No. 27, Angers 331
86. Entraining class D patients at Base Hospital No. 30, Royat 335
87. Map of AUerey hospital center and vicinity 490
88. Reservoir, AUerey hospital center 492
89. Exterior view of warehouse, AUerey hospital center 501
90. Interior of receiving ward, AUerey hospital center 508
91. Delousing apparatus, AUerey hospital center 512
92. Clothing preparatory to delousing process, AUerey hospital center 513
93. Interior of one of the quarters for enlisted men, AUerey hospital center 514
94. Heating apparatus for patients' baths, AUerey hospital center 515
95. An operating room, AUerey hospital center 523
96. Sterilization room, AUerey hospital center 524
97. A surgical ward, AUerey hospital center 525
98. A psychiatric ward, AUerey hospital center 526
99. Eye and ear clinic in one of the hospitals, AUerey hospital center 527
100. Center medical laboratory, AUerey hospital center 529
101. View of Bazoilles hospital center 53g
102. Covered walk connecting the wards at Base Hospital No. 18, Bazoilles hospital
center g^j
103. Airplane view. Beau Desert hospital center g^g
104. Beau Desert hospital center, showing railway facilities 549
105. An operating room, Beaune hospital center
106. A view of part of Kerhuon hospital center gg-r
107. A view of part of Limoges hospital center g-r^
108. General view of Mars hospital center, looking northeast from tower at west end
of center
109. One of the operating rooms. Mars hospital center
110. View of convalescent camp (east end) looking north from water tower Mars
hospital center
111. A view of part of Mesves hospital center, during the construction period. . 580
TABLE OF CONTENTS 11
Page
112. A row of wards, Mesves hospital center, during construction period 581
113. Rock quarry, used in construction of Mesves hospital center 582
114. Base hospital. No. 99, Hyeres, Riviera hospital center 594
115. Base hospital No. 93, Cannes, Riviera liospital center 595
116. Evacuation Hospital No. 49, Menton, Riviera hospital center 596
117. Airplane view, Savenay hospital center 597
118. Hotel des Bains, part of Vichy hospital center 619
119. Hotel Lilas, part of Vichy hospital center 620
120. A ward. Base Hospital No. 1, Vichy hospital center 621
121. Officers' mess at the Hotel Sevigne, Vichy hospital center 622
122. Casino, used as the officers' club, Vichy hospital center 623
123. Building used as the noncommissioned officers' club, Vichy hospital center 624
124. Two small hotels used for the enlisted men, Vichy hospital center 625
125. Base Hospital No. 3, Vauclaire 631
126. Airplane view of Base Hospital No. 7, Joue-les-Tours 635
127. Base Hospital No. 9, Chateauroux 637
128. A general medical ward, exterior. Base Hospital No. 12, operating British
General Hospital No. 18 639
129. Exterior, surgical ward. Base Hospital No. 12 640
130. Base Hospital No. 15, Chaumont 643
131. Base Hospital No. 17, Dijon 644
132. A view of part of Base Hospital No. 21, operating British General Hospital No. 12,
Rouen 648
133. A view of part of the temporary buildings. Base Hospital No. 27, Angers 653
134. Base Hospital No. 28, part of Limoges hospital center 654
135. Surgical building. Base Hospital No. 29 656
136. Airplane view. Base Hospital No. 30, Royat 657
137. Base Hospital No. 33, Portsmouth, England 660
138. Contagious disease ward. Base Hospital No. 40, Sarisbury Court, Hants, England- 666
139. A view of the grounds, Base Hospital No. 41, St. Denis, Paris 667
140. View of part of Base Hospital No. 43, Blois 669
141. Base Hospital No. 57, Paris 682
142. Base Hospital No. 85, Paris 704
143. Part of Base Hospital No. 94, Pruniers 713
144. Main building. Base Hospital No. 103, Dijon 721
145. Main kitchen. Base Hospital No. 106, Beau Desert hospital center 724
146. Interior, detachment mess. Base Hospital No. 106 725
147. Base Hospital No. 236, Carnac 747
148. Camp Hospital No. 2, Bassens 750
149. Camp Hospital No. 4, Joinville 751
150. A ward interior. Camp Hospital No. 7, Humes 752
151. Camp Hospital No. 22, Langres 757
152. Camp Hospital No. 24, Langres 759
153. Interior, officers' ward. Camp Hospital No. 28, Nevers 760
154. A group of wards, Camp Hospital No. 29, Le Courneau 761
155. Camp Hospital No. 33, Camp Pontanezen l 762
156. Camp Hospital No. 41, Is-sur-Tille 766
157. Camp Hospital No. 42, Bar-sur-Aube 767
158. Camp Hospital No. 45, Aix-les-Baines 769
159. Camp Hospital No. 46, Landerneau 770
160. Camp Hospital No. 48, Recey-sur-Ource 771
161. One of the buildings. Camp Hospital No. 56, Avoine 774
162. Camp Hospital No. 59, Issoudun 776
163. Camp Hospital No. 64, Chatillon-sur-Seine 777
164. Camp Hospital No. 68, Bourges 779
165. Camp Hospital No. 72; Chateau-du-Loir 780
f
INTRODUCTION
MILITARY ATTACHES AND OBSERVERS, MEDICAL OFFICERS WITH
SPECIAL DUTIES, HOSPITAL UNITS AND CASUAL PERSONNEL
ON DUTY WITH ALLIES
MILITARY ATTACHES AND MILITARY OBSERVERS
When war was declared by Germany on July 30, 1914, there were on duty
with the principal American embassies and ministries accredited to European
governments military attaches who were charged with the duty of procuring
and forwarding military information to the chief of the War College division of
the Army General Staff. ^ In some countries their efforts were supplemented
later by those of military observers — officers who occupied a status somewhat
different from that of attaches but who, like them, w^ere assigned to duty with
the respective embassies and accredited to the governments concerned.^ Gen-
erally speaking, the observers enjoyed greater opportunities for investigations
at the front than did the attaches, for they were .assigned, as their designation
would indicate, with that end in view, though in some instances the opportu-
nities afforded them were strictly limited by the government to which they were
accredited.^ Though the military attaches were the military advisers of the
ambasssadors under whom they served, and were charged more definitely with
reporting to the Army War College current military events and military policies
in so far as these were divulged,^ they also submitted many reports covering a
wide range of other subjects.
On August 12, 1914, the Secretary of War requested the Secretary of State
to learn whether or not England, France, Germany, and Austria would accept
as observers six officers of the line and two of the Medical Department.^ The
Secretary of War was notified, on August 17, that the Austro-Hungarian
Government was willing to accept two line officers and two medical officers.^
Later this authorization was so modified as to replace one medical officer by
another officer from a different branch of the service.^ On August 19 the
military attache in London notified the War College division of the General
Staff that two military observers, in addition to the military attaches, would be
permitted to accompany the British Army in the field. ^
The Chief of Staff informed the Surgeon General, on August 12, 1914, that
medical officers who might be detailed as observers should be governed by
General Orders, No. 60, War Department, August 8, 1914, which requested and
advised all officers to refrain from public comment upon the military or political
situation where other nations were involved.''
On September 1, 1914, an officer of the Medical Corps, then in Europe,
together with three officers from other branches of the Army, was directed to
report to the American ambassador in Vienna for duty as military observer
with the Austro-Hungarian Army.''' He served in this capacity at various places
along the Russian and Serbian fronts until October 27, 1915.
14
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
On September 9, 1914, another officer of tlie Medical Corps, then in London,
was assigned as military observer with the French Army,'- and served in that
capacity until November 23 of that year.'^
On January 30, 1916, Sir William Osier, regius professor of medicine, Oxford
University, England, recommended that three medical officers of our Army and
and an equal number of our Navy be detailed to study professional procedures
in British base hospitals.'^ The recommendation, having been referred to him,
the Surgeon General, on March 6, 1916,'" selected three members of the Medical
Corps, who were then assigned and accredited as military observers."^ After
reporting in London in May, these officers made extensive observations in
matters pertaining to the British medical service both in England and on the
continent.
No officer of the Medical Corps w^as a member of the group assigned as
military observers with the German Army.'^
The medical officers assigned as military observers w^th the British Army
remained in this status until the arrival of General Pershing in June, 1917,''*
when they vacated their assignments and joined the American Expeditionary
Forces,'^ except one, who retained his status as observer and his consequent
affiliation with the American Embassy,-" on June 9, 1917, in addition to his
other duties, being made liaison officer for our Medical Department with the
British forces, with office in London.^' Shortly thereafter he was assigned as
chief surgeon of the American forces serving with the British, his status in this
matter being analogous to that of a department surgeon in the United States.
Another of these medical officers, after joining the American Expeditionary
Forces, was assigned, on July 4, to duty at Base Section No. 1 (St. Nazaire),
where he had been conducting an inspection when headquarters, A. E. F.,
arrived;^* the third or senior medical officer become chief surgeon, A. E. F., on
May 26, 1917, by General Orders, No. 1, headquarters, A. E. F., Washington,
D. C.
Meanwhile, on February 23, 1917, the British had recommended that a
veterinary officer of the United States Army be detailed to observe the oper-
ations of his branch of the service in their army.^^ Accordingly, a veterinarian
attached to the 6th Field Artillery, who had been assigned as a military observer
with the French Army, December 27, 1915,^*^ was relieved from further duty
in France on March 10, 1917, and directed to report to the American ambas-
sador at London for the purpose of carrying out instructions of the War Depart-
ment.^^ On June 14, 1917, this officer was relieved from further duty in London
ordered to Paris, and assigned to duty in the American Expeditionary Forces.-*
These several observers with the British Army submitted numerous reports
many of which w-ere very thorough and elaborate, and all of w^hich were tech-
nical, concerning organization, administration, equipment, and tactics of the
British Army medical service, sanitation, preventive and curative medicine
surgical and orthopedic technique, offensive and defensive measures in gas
warfare, transportation of wounded, care of animals, and many other subjects.
A few^ of their reports pertained to the British Navy; e. g., hospital ships
On June 5, 1915, the chief of the War College division of the General
Staff approved and forwarded to the Surgeon General a letter from the Amer-
INTKODUCTION
15
ican military attache, Paris, requesting detail of a medical officer as an observer
with the French Army.^* On June 12, the Surgeon General, concurring in this
proposal, recommended a medical officer,^" who was assigned on November 15,
1915, as military observer with the French armies in the field.^^
In conformity with a request from the German Government dated Sep-
tember 1, 1916, that two medical officers of the United States Army be detailed
to inspect depots for prisoners of war in France,^^ the Surgeon General, on
September 12, recommended that a medical officer be assigned to that duty to
supplement the activities of the one who already was available for that service.^^
On September 25, 1916, the newly assigned medical officer was detailed as a
military observer.^* This was not in order that he might perform the functions
of an officer regularly so accredited, but in order that his status might be fixed
while on detached duty, and that he might receive an allotment from the appro-
priation for military observers abroad.^^ The primary purpose in sending him
to France was that he might assist in the inspection of depots for military
prisoners, but in point of fact he not only did this but also made a number of
such observations as were regularly incumbent upon a military observer.
In addition to the two medical officers referred to above other officers
belonging to different branches of our Army were serving as military observers
accredited to the French Government.^^ On July 19, 1916, six of these officers
joined in signing a letter addressed to the chief of the War College division,
General Staff, recommending that they be organized into a mission.^^ This
letter noted the advantages that would accrue from the recognition of an
American military mission by the French War Department and stated that
they were all recognized as being members of such a group but that they had
no designated head who could represent them in their transactions with the
French Government.^^
The mission was organized by authority of the following letter of November
21, 1916, from the acting chief of the War College division. General Staff
By authority of the Secretary of War, the officers now on duty in Paris as military ob-
servers have been organized into a mission of which you are hereby appointed chief.
The Secretary of War directs that in the performance of your duties as chief of this
mission you be guided by the following instructions:
(a) You will cooperate in the fullest possible manner with the military attache at Paris
in the work of procuring military information, to the end that there be no duplication of work.
(b) You will show to the military attache all reports of the military observers prepared
for transmittal to the War College division. Such reports will be numbered serially in the
office of the military observers in such a manner that they will not be confused with the
numbered reports of the military attache. Reports of the military observers will be acknowl-
edged by the War College division directly to the chief of the military mission once a month.
(c) All requests from the War College division for information to be compiled by the
military observers will be directed to you, and it will be your duty to inform the other military
observers of the information that is desired.
(d) All the arrangements between the office of military observers covering all questions
or requests will be carried on directly between you as chief of the mission and the military
attache.
(e) The retained reports of the individual military observers will be accessible at all
times to the military attache, and conversely all reports of the military attache covering mat-
ters of routine military interest will be open to the military observers.
13901—27 2
16
ADMINISTRATION, AMERICAN EXPEDITIONARY KOHCES
(/) As chief of this mission you are authorized to coiuinuiiicate directly with tlie trench
War Department to such an extent as may be permitted by the hitter department. ou will,
liowever, keep the military attache informed of such matters as are taken up directly by you
with the French War Department.
(g) In order that the greatest possible advantage may be taken of all possible channels to
procure military information, you are directed to cooperate to the fullest extent with the
military attache.
(h) Instructions have been issued to the military attache at Paris to officially present you
to the chief of the second bureau of the French General Staff as chief of the American military
mission upon the receipt of the acknowledgment by the French authorities of your assignment
as such, which is being communicated to them through the Department of State.
(i) The Secretary of War authorizes you as chief of this mission to issue such instructions
to the members thereof as may be necessary for the proper performance of their duties.
Before the severance of the diplomatic relations between the United
States and Germany, February 3, 1917, members of the mission were not
given such opportunities as they later enjoyed,^* for prior to that event the
French were not certain where the sympathies of our Government lay, and
naturally hesitated to permit American officers to make thorough inspections.^
During that period, nevertheless, members of the mission did enjoy certain
facilities and submitted a number of reports on many subjects.^ After Feb-
ruary 3, 1917, the mission's facilities for study of military methods and activi-
ties were greatly extended and it forwarded to the War College a great quantity
of information, much of it highly technical in character.^ Revised instructions
for the guidance of Medical Department military observers were sent to the
chief of the mission and to the medical observers in England on February 10,
1917.^^
On February 14, 1917, the chief of the mission reported that at his request
General Lyauty had given directions so greatly amplifying the privileges here-
tofore granted the American mission that it enjoyed practically ''blanket"
permission for obtaining any information it might seek.^^ It was arranged
that the two medical members would visit the French Army school of asphyx-
iating gases and all medical depots, and would study on the ground the whole
system of evacuation of wounded from the trenches to the base hospitals.^*
Accordingly, these medical officers took the full course of instruction at the
French gas school and submitted a voluminous report covering confidential
matters concerning the chemistry of gases employed, their manufacture,
tactical employment, defenses against them, and the organization of the gas
services of the French and German Armies. A study of the evacuation service
was prosecuted, but as indicated below was not completed until after the
United States entered the war. On February 9, one of the medical officers in
question reported at length, among other subjects, on the organization of the
French sanitary service and the operation of that service in campaign. He
also compiled additional data concerning French and British defensive gas
service which he later submitted to the chief of the Gas Service, A. E. F., when
headquarters arrived in France.
A report submitted by the two medical members of the American military
mission April 25 gave the results of a study of Medical Department organi-
zation required for any expeditionary force that might be sent to France.
This document included statistics of wounded and a detailed description of
INTRODUCTION
17
the i-adical reorganization of our service that would be required, and was
accompanied by inclosures which discussed the general organization and admin-
istration of French medical service, with particular reference to their depots
for the slightly sick and wounded and convalescent camps. Another report
considered the utilization of volunteer American sanitary units in France.
Following the declaration of war, on April 6, 1917, the War Department
called upon the mission through the miUtary attache for specific information
on many subjects, and the facilities afforded members of the mission by the
French, in order that they might furnish promptly and thoroughly any data
required, were further extended by the detail to service with it of several
officers of the French General Staff.^ They assisted in preparing surveys of
ports, reports on condition and capacity of railways, location of training camps,
depots, and other installations.
The mission reported to the War Department, on June 1, that for various
reasons St. Nazaire and Nantes appeared to offer the best facilities for debarka-
tion for the first American forces, and recommended on that date that such
troops should be disembarked at St. Nazaire.*" Accordingly, the French
were requested to construct at this place a cantonment adequate to shelter a
division of 20,000 men.^ It was also reported that because of the great con-
gestion of this port it was advisable that our main central supply stations be
located at Nevers where the French were prepared to transfer the station ware-
houses to the United States forces.^ It was recommended that training camps
be located in the vicinity of Nancy and Toul. The following day two officers
of the mission left for St. Nazaire to lay out the camp site and establish water
supply services.^ The explicit applied problems of the Medical Department
in France now began, for the water supply at St. Nazaire was not sufficient for
the number of troops to be encamped here, and provision had to be made to
overcome the deficiency.^ This was accomplished temporarily by placing
water boats in service on the Loire to carry water from points some miles
inland.^ One of the medical members of the mission had been charged with
initiating necessary measures for rendering potable the water supply for our
forces in France, and on May 19 had reported on the service of water in the
French Army. As soon as the provision of a suitable water supply at St.
Nazaire was settled the French harvested such of the crops on the prospective
camp site as were sufficiently matured and began to erect the huts required
and to install the camp water system.^ It was arranged that the sick would be
cared for in a double-walled barrack hospital accommodating 300 beds, but
after construction was well advanced word was received that the strength of a
division had been increased to some 28,000 men, and it became evident that
the buildings intended for hospital purposes would have to be utilized as bar-
racks by the incoming troops.^ In this emergency the French were appealed
to and at once turned over in St. Nazaire a military hospital with a capacity
of 250 beds, the only military hospital in that community, and another of 500
beds at Savenay, a few miles inland.^ Arrangements w^ere also made for the
transfer of a hospital of 500 beds at Nantes and for the eventual transfer of
several others, notably one of 1,100 beds at Bordeaux, but, as no personnel had
yet arrived, definite arrangements concerning the latter institutions were held
in abeyance until after the arrival of the commander in chief.^
18
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Meanw hile, other activities also engaged members of the mission. A medical
member of the mission, continuing investigations begun several months pre-
viously, visited the front, where he made an exhaustive stud}^ of the organiza-
tion of the French Medical Department, its system of field hospitalization,
classification of nonevacuable sick, evacuation of wounded by hospital tram,
medical supply, use of motorized sanitary organizations of various kinds
(e. g. ambulance companies, surgical hospitals, radiologic, laundry, and other
units) and related subjects. On May 31, he reported his observations, but the
most valuable result of this study accrued from the fact that when our troops
began their offensives, in May of the following year, he was able, because of
his then assignment with G-4, G. H. Q., to give direct application to the results
of these observations, and thus secure to the medical service at the front better
cooperation than might have been possible from others not personally acquainted
with the study made at this time.^' With a view of avoiding delay when our
troops would begin to arrive, studies by the members of the American military
mission, accompanied by officers of the French General Staff, were continued
and new ones undertaken. These included further inspections of the railway
systems and selection of locations for temporary supply depots.^ It was also
decided, tentatively, that the first division that arrived should go into the
training area around Gondrecourt. Here a small barrack hospital w^as taken
over from the French who evacuated their patients.^ Construction to expand
this unit to 300 beds was begun immediately and the French reequipped it with
new material throughout, for it was realized that our own supplies would not
at once be available.^
The members of the mission continued their activities in their assigned
capacities until the arrival of General Pershing in Paris on June 13. In con-
formity with instructions received by the chief of the mission on June 5,*^
that officer reported at the time in question to General Pershing with a view of
informing him as fully as possible concerning existing conditions.^ At this
time all members of the mission joined the staff of the commander in chief
and began the performance of new duties, continuing, however, a number of
investigations which they had commenced prior to his arrival.
MEDICAL OFFICERS CHARGED WITH SPECIAL DUTIES IN FRANCE
On October 18, 1916, the Surgeon General requested that he be authorized
to detail one of our medical officers for duty as superintendent, or officer in
charge of a hospital at Passy, France, which was under the direction of the
French Benevolent Society of New York, and requested that this officer be
granted leave of absence for four months for that purpose.*^ The leave was
granted,*^ and the officer in question was informed that he would go to France
in a personal capacity, would have no connection with the United States Service
and could not wear the uniform while in that country.*^ On May 7, 1917 the
United States having declared war, he was formally assigned to duty at the
hospital mentioned,*^ but on May 22, the Surgeon General notified the French
Benevolent Society that this officer had been placed on a duty status, the
United States having entered the war, and that all officers were needed.*"' He
also requested information as to when he might be replaced. This officer
INTBODUCTION.
19
retained this assignment until October 3, 1917.^^ A few days later he was
transferred to Blois and assigned as sanitary inspector of the line of com-
munications, A. E. F."
Previous, but unsuccessful, efforts had been made by the Surgeon General
to have another medical officer assigned to duty at the above-mentioned hospital
at Passy, but at that time (June, 1916) this assignment was disapproved by
the President on the ground of neutrality. The officer, however, was selected
later to serve as chief medical officer of a hospital at His Orangis, France.
This officer was instructed to apply for leave and was assigned in the same status
as the one referred to in the preceding paragraph, but while en route his orders
were changed because of the entry of the United States into the war,^° and he
was definitely assigned to duty at this hospital May 7, 1917.^^ Here he served
as chief medical officer and conducted a large surgical clinic until assigned to
duty at general headquarters, A. E. F., on March 7, 1918,^^ meanwhile dis-
charging a number of other duties pertaining to the standardization and pro-
curement of splints, manufacture of nitrous oxide, and instruction of newly
arrived medical officers in surgical technique.
On April 9, two additional medical officers ^^-^^ were granted leave for service
in the hospital at Ris Orangis." On May 7, they were definitely assigned
thereto," but on July 6, one was made one of the assistants to the chief surgeon,
A. E. F.," and on August 15, the other was detailed as commanding officer of
United States Army Hospital No. 2.^^
BASE HOSPITAL PERSONNEL AND CASUAL MEDICAL OFFICERS, UNITED
STATES ARMY, WHO SERVED WITH THE BRITISH EXPEDITIONARY
FORCE BEFORE THE ARRIVAL OF HEADQUARTERS, A. E. F.
Prior to the entrance of the United States into the war a number of Amer-
ican citizens served individually in various capacities in the allied armies. A
number of others were members of organizations, composed largely, if not
entirely, of Americans, which were under the military control of some European
government.^' Several of these formations were later absorbed or taken over
by the American Expeditionary Forces (e. g., the Ambulance Americaine, later
American Red Cross Hospital No. 1, the ambulance field service, and American
Red Cross Ambulance, later incorporated in the United States Army Ambulance
Service), but until that time were not a part of our forces.^°
The elements of the American Army, other than the military attaches,
military observers, and the military mission to France (discussed above),
which first served in Europe after the declaration of war, were six base hospitals
which had been organized by the American Red Cross, and inducted into
service soon after the United States entered the war,''' and were now assigned
to duty with the British Expeditionary Force in France.^^ Also certain casual
medical officers were assigned to duty with the British or French armies.®^
The circumstances which led up to the rendition of such prompt service
and the composition and equipment of these units are discussed in Volume I,
Chapter II, of this history.
When the British and French missions arrived in Washington in April,
1917, Col. Thomas H. Goodwin, of the Royal Army Medical Corps, requested
20
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCEJ?
that six base hospitals and 116 casual medical officers be assigned to the British
Expeditionary Forces.''* The War Department called on the American Red
Cross to furnish the hospital units for immediate transportation to France.''^ On
May 1, 1917, the Surgeon General wrote The Adjutant General that it was the
former's expectation that in the next three or four months, his department
would send about 1,000 medical officers to Europe for service with the British
Army and that they would begin to go over as rapidly as the Quartermaster
Department could furnish transportation.'*'' The hospitals selected sailed in the
following order, between the 8th and 25th of May:
Base Hospital No. 4, organized at the Lakeside Hospital, Cleveland, Ohio.
Base Hospital No. 5, organized at Harvard University, Boston, Mass.
Base Hospital No. 2, organized at the Presbyterian Hospital, New
York City.
Base Hospital No. 10, organized at the Pennsylvania Hospital, Phila-
delphia.
Base Hospital No. 21, organized at the Washington University, St.
Louis, Mo.
Base Hospital No. 12, organized at the Northwestern University, Chicago.
To some of these units additional personnel was attached; e. g., a group
of orthopedic surgeons was attached to Base Hospital No. 21.^^
After arrival in France the hospitals operated until after the signing of
the armistice as general hospitals, British Expeditionary Force in France.
They were located as follows:"^
No. 4, Rouen — operating British General Hospital No. 9.
No. 21, Rouen — operating British General Hospital No. 12 .
No. 2, Etretat — operating British General Hospital No. 1.
No. 10, Treport — operating British General Hospital No. 16.
No. 12, Dannes Camiers — operating British General Hospital No. 18.
No. 5, Dannes Camiers — operating British General Hospital No. 11.
On November 1, 1917, Base Hospital No. 5 was transferred to Boulogne
where it operated as British General Hospital No. LS."^
On May 21, 1917, the American attache at London recommended that our
senior medico-military observer there be designated as chief surgeon for all
American medical units and personnel serving with British medical service,
such assignment being urgently indicated in order to coordinate and systematize
the relations which must exist between the two services."**
Some weeks prior to the arrival of General Pershing, the medical officer
referred to in the preceding paragraph reported to the Surgeon General that he
had assumed an unauthorized supervisory control over the American Medical
Department personnel which had arrived in England before the commander
in chief, for service with the British forces."^ He stated that his position under
these circumstances was such that he could neither act nor advise in any
authoritative manner, and that his relation with British authorities had been
purely advisory."^ No instructions of any kind concerning this personnel had
been received from Washington, though by June 11, 1917, 6 base hospitals
and 52 casual medical officers had reported.^^
INTEODUCTIOX
21
On May 26, 1917, by General Orders No. 1, headquarters, A. E. F.,
Washington, D. C, he was designated as chief surgeon of the United States
forces in Europe,^" to exercise over the forces under his control the same author-
ity as the Suregon General holds over the entire Medical Department.'''
Control of the Medical Department personnel serving with the British
was taken up by the chief surgeon, A. E. F., with General Pershing after the
latter's arrival, and this responsibility, on June 25, was vested in the liaison
officer for the Medical Department with the British.
GENERAL ORGANIZATION AND DEVELOPMENT OF THE AMERICAN
EXPEDITIONARY FORCES
The provision of a suitable organization for the American Expeditionary
Forces by the creation of a staff which could give it intelligent direction was
one of the first subjects that, from the outset, had engaged the attention of
the commander in chief."' He had formulated a tentative plan for this essen-
tial even before he embarked, and his headquarters had continued to study
this subject while on shipboard and after arrival in Paris.'- Our Field Service
Regulations provided certain guiding principles, but the experience and theory
upon which they were based antedated the beginning of the war in Europe,
and it was necessary that they be revised in the light of its developments."
It was essential not only that the necessary staff services, as determined by
developments of the war, be created, but also that the general scope of their
individual and collective activities be defined, that the responsibilities of each
staff service be fixed specifically, that overlapping or conflict of jurisdiction be
eliminated, and that work be decentralized and individualized in designated
offices.
In several important respects our position was different from that of any
of the allied nations, and this fact had its influence in the application of the
results of the comprehensive study, begun on the S. S. Baltic and now inten-
sively continued, of British and French staff" organizations.^' The French
Army was fighting on its own soil, had immediate access to its War Depart-
ment and to its civil government, and was close to the territory from which it
procured most of its supplies."' The British Army, though organized on an
overseas basis, was also in close contact with its home Government and base."'
But the American Army was based on a continent 3,000 miles distant, with
which communication was much more difficult; its organization, administra-
tion, and supply, therefore, offered peculiar problems.
It was foreseen that the uncertainties incident to ocean transport in the
face of the growing submarine menace, the limited, though yet unknown,
quantity of ship tonnage that would be available, and a line of land commu-
nications some 400 miles in length through a foreign country already strained
by protracted war, would give rise to problems of organization, administration,
and supply that would be almost insuperably difficult." At the outset the
commander in chief had made the announcement that the expedition was to
be under control of its general staff, which was charged with its orderly, sym-
metrical, and balanced development.^^ No one arm, bureau, or department
was to be developed in advance of its needs or at the expense of others, but, as
shown below, this ideal had to be modified because of military necessities."^
22
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Study of present and prospective problems in their intrinsic and extrinsic
aspects led to the promulgation, on July 5, 1917, of General Orders, No. 8,
G. H. Q., A. E. F., which provided for the creation of a general staff and technical
administrative bureaus of the American Expeditionary Forces. This order,
which was to form the basis of coordinated activities, directed that the general
staff be divided into three major sections, intelligence, operations, and admin-
istration, each under an assistant chief of staff; apportioned various duties
among them ; provided for an administrative and technical staff, consisting of
the chiefs of nine staff departments — adjutant general, inspector general, chief
surgeon, and others — created the line of communications, and specified the
duties of the American Red Cross. The organization of the American Expe-
ditionary Forces was yet in a formative state, however, and a corrected copy
of General Orders, No. 8, G. H. Q., A. E. F., published August 14, 1917 (but
as of July 5), provided for a chief of staff, a secretary to the general staff, a
general staff divided into 5 sections, an administrative and technical staff
consisting of 15 departments, and a headquarter's command.
Both editions of this order provided that the distribution of staff duties at
the headquarters of subordinate commands should conform in principle to the
distribution of duties prescribed for headquarters. It is sufficient here to
state that duties assigned to the several sections of the general staff at this time
were as follows: First section, administration; second, intelligence; third, opera-
tions; fourth, training; fifth, coordination. The duties of the several sections,
as they applied especially to the Medical Department are discussed more fully
below.
The administrative and technical staff designated by this order consisted
of the following: Adjutant general, inspector general, judge advocate, chief
quartermaster, chief surgeon, chief engineer officer, chief ordnance officer, chief
signal officer, chief of Air Service, general purchasing agent, chief of Gas Serv-
ice, director general of transportation, commanding general line of communi-
cations, chief of Red Cross, provost marshal general.
The chiefs of the administrative and technical staffs were the local repre-
sentatives of those bureaus of the War Department who were entitled to mem-
bership in the headquarters of our forces in the field or the chiefs of several
newly created staff organizations, viz, the general purchasing board, the
department of transportation, the line of communications, the American Red
Cross." These services were given staff representation in order that new situa-
tions might be met. Like the heads of other bureaus composing the technical
staff, their chiefs were equivalent in rank, and were coordinated with one
another, and with the chiefs of previously existing staff departments whom
they divested of some of their duties." Activities of ah these administrative
staff b ureaus were directed and coordinated by the general staff, whose mem-
bers as representatives of the commander in chief, communicated his plans
with a view to their execution to the chiefs of the bureau concerned." By
analogy to bureau chiefs in the War Department, their similars in the American
Expeditionary Forces were charged with duties incident to administration
statistics, records, inspection, construction and operation in their respective
jurisdictions, including the procurement of the necessary supplies and material
INTRODUCTION
23
and forwarding these as required to the forces in the field/^ They were the
advisers and executives of the commander in chief and his general staff in all
matters, including those of a technical character incident to the operation of
their respective departments.^^
In the early period of the American Expeditionary Forces the Medical
Department was concerned chiefly with the first and fifth sections of the general
staff/* The first, among its other duties pertaining to general matters of
administration, was then charged with replacements, evacuation of sick and
wounded, the ratio of combat troops to those serving on the line of com-
munications, the respective ratios of staff and combat troops, supplies and
transportation.^* The fifth was charged at this time with coordination and
application of administrative staff policies.^* The importance to the Medical
Department of the first section was incident especially to its control of allow-
ances of ocean transport for personnel and supplies, and that of the fifth to its
control of all hospitalization and depot projects — determining their need, size,
location, installation, and other attributes.^* Not infrequently several staff
departments sought the same facilities and the fifth section coordinated these
conflicting demands.^*
The duties of the several sections of the general staff and of the technical
staff departments varied somewhat in accordance with successive reorganiza-
tions, especially those prescribed by Memorandum 129, published November
19, 1917; General Orders, No. 31, published February 16, 1918; General Orders,
No. 114, published July 11, 1918; and General Orders, No. 130, published
August 6, 1918.
Coincident with the organization of the general staff of the American
Expeditionary Forces reorganization of the Army units was effected. As
such units provided by our Tables of Organization when we entered the war
were so small that they were quite inadequate for the service now required,
an entirely new organization was prescribed. This provided that an Infantry
combat division should consist of 28,172 officers and men, and should be com-
posed of 2 infantry brigades, 1 field artillery brigade, 1 machine-gun battalion,
1 regiment of engineers, 1 field signal battalion, military police, train
headquarters, and ammunition, supply, and sanitary trains." The sanitary
train originally consisted of train headquarters, 4 field hospitals, 4 ambulance
companies, and 8 infirmaries,^^ but from time to time other organizations and
equipment were added, e. g., a medical supply depot, a mobile laboratory,
and as occasion required and resources permitted a mobile surgical unit and
professional teams were attached to it." Similarly there later developed great
expansion in corps and armies and in organizations which served in the line of
communications."" For example, the depot division at Aignan (the 41st Divi-
sion) attained a strength of over 50,000 officers and men,^^ and the capacity
of base hospitals was increased from 500 to 1,000 beds, or to 2,000 beds in
emergencies — the so-called ''crisis" expansion. In point of fact many of
these hospitals exceeded 3,000 beds during the Meuse-Argonne operation.
New agencies in practically all services were developed and some reached a
degree of importance which caused them to be made autonomous staff depart-
ments, their chiefs becoming members of the administrative staff of the Ameri-
24
ADMINISTRATION, AMERICAN KXPEDITIONAHV FORCES
can Expeditionary Forces, e. g., the Motor Transport Corps. Throughout
its history there was a progressive development of the administrative services
of the American Expeditionary Forces, the direction of this evohition being,
with but one exception and that transient, toward decentraUzation.**"
The prospective disembarkation of several million men, their movement
to training areas, provision for their shelter and the handling, storage, and
distribution of the supplies and equipment required, called for an extraordinary
and immediate effort in construction.*'
To provide the organization for this purpose, a project for engineer services
of the rear, including railw^ays, docks, depots, hospitals, etc., was cabled to
Washington, August 5, 1917, followed on September 18, 1917, by a complete
project for the rear, which listed by item the troops considered necessary for
the Services of Supply.*' Under this project the strength of the rearward
services, from the firing line to base ports, w^ould constitute about 35.5 per
cent of the entire expeditionary force, for it included divisional, corps, and
army trains and similar noncombatant organizations at the front, as well as
the personnel operating ports, depots, transportation, and other facilities.**^
Despite our longer line of communications this percentage was less than that
of the British whose rearward services absorbed 37.5 per cent of their total
expeditionary strength, while steps were being taken to increase this to 40 per
cent.^^ To the strength called for by the organization project (1,000,000 men),
this project added 329,653 men, bringing the total for a balanced force, con-
forming to the organization project, to 1,328,448 men.*- The line of com-
munications projects called for approximately 25 per cent of this total, but
because of military exigencies that command never received the full quota of
troops required for its installations and activities. *-
Beginning on July 6, 1917, a series of cables was sent to the War Depart-
ment fixing the order in which troops should arrive, but it was evidenct that these
cables were of but transient value and that the W^ar Department should be
furnished a comprehensive statement of the personnel and supplies needed, in
order that there might be built up a balanced and symmetrical force, appro-
priately supplied and equipped.*' Therefore, a schedule of priority shipment of
personnel was prepared covering the order in which the troops should be sent
to Europe.*' This schedule, approved by General Pershing and forw^arded to
the War Department on October 7, divided the initial force called for into six
phases, corresponding m general to combatant corps of six divisions each.*^
The French minister of war assigned to duty with headquarters of the
American Expeditionary Forces, than at Chaumont, a special liaison officer
who w^as the channel of communication between his office and the commander
in chief, A. E. F.*^ The French high command also estabhshed at Chaumont
a French mihtary mission which was organized with the same divisions or
bureaus as the French General Staff.** One of its sections was charged with
Medical Department matters. This mission had full authority to act for the
French Ministry of War and the French commander in chief in all matters
concerning the relations of the various American services and those of the
French armies, both in the French zone of the armies and the zone of the in-
terior.»* The chiefs of the administrative and technical services of the Ameri-
INTRODUCTION
25
can Expeditionary Forces were authorized to communicate directly with this
French mission in all matters that concerned the operation of their particular
services, except such as involved questions of policy. Communications on
subjects in that category were prepared for the signature of the chief of staff
and submitted to him.^^ All questions of whatever nature affecting the medical
services in the zone of the army were handled through the office of the medical
member of this mission.^'
The commanding general, Services of Supply, A. E. F., the general pur-
chasing agent and the director general of transportation were authorized to
communicate directly with the various services in the French zone of the in-
terior in all matters coming under their own particular control providing such
correspondence did not involve questions of policy.^^ If it did, they prepared,
initialed, and submitted letters for the signature of the chief of staff, A. E. F.,
but when the question at issue required the action of any French service in
the French zone of the armies, the letter was prepared for the signature of the
commander in chief.
Both before and after the provision of our liaison service, conferences con-
cerning problems of importance, were held from time to time between high
officers of our service and those of our allies. Among these were the confer-
ences held by General Pershing with the commander in chief of other forces
and those conducted by members of the general staff or the chiefs of admin-
istrative staff departments.^"
The American forces were also represented on a number of interallied
councils which were chiefly concerned with procurement. The Allied Mari-
time Transport Council was engaged primarily in provision of tonnage in relation
to the four main requirements, viz, food, munitions, raw materials, and fuel
supply of the American Expeditionary Forces during 1918-19.*^
The resources of our allies in men and material had been taxed to very
grave limits, but they always stood ready to furnish us with needed supplies,
equipment, and transportation when these were at all available. The develop-
ment of our program for construction, transportation, hospitalization, and other
essential activities predicated the highest degree of cooperation between the
American and allied services.**
With the growth of the American Expeditionary Forces the activities of
the several sections of the general staff not only became greatly intensified but
also widely extended in scope. The first section engaged in development of
policies, and the fifth (which, as is explained below, later became the fourth
charged with supply and coordination) continued to be of special interest to the
Medical Department.*' The fifth section necessarily supervised more and more
closely the activities of the various supply bureaus with a view of balancing
effort and keeping all establishments on a corresponding footing.*' As problems
increased in number and complexity it developed that the division of duties
• and responsibilities between the coordination and administration sections were
not fully understood outside of the sections themselves.*^ These were redis-
tributed to a degree, by Memorandum No. 129, H. A. E. F., November 19,
1917, in which the duties of each of these sections were carefully defined.*^
The same order which decentralized and simplified staff methods of adminis-
26
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tration, also indicated the direction in which the fifth, or coordination section,
was developing by specifying its duties as follows: ^°
All questions concerning supply and transportation in France. Operations of the
technical services except the Red Cross, Y. M. C. A., and other similar agencies, the General
Pershing Board, War Risk Bureau, auditors, and Field Ambulance Service. Operations of
the line of communications and the transportation department. Statistics concerning
supply, construction, and transportation. Supply and transportation arrangement for com-
bat. Assignments of labor and labor troops. Location of railway and supply establish-
ments. Hospitalization and evacuation of sick and wounded. Orders for assignment of
new units.
In the meantime, studies of the British and French systems of staff organiza-
tion as well as our own were continued with the result that a system giving
more thorough staff coordination and control of the important services of con-
struction, transportation, and supply was evolved.^*' Among other changes,
the evolved system restricted the jurisdiction of the coordination section in
the supply of the American Expeditionary Forces to matters intrinsic to that
command and delegated to the first (administrative) section the supervision
of procurement from the United States, the allotment of tonnage, and the
arrangements for transportation to France, while the coordination section con-
tinued to deal with questions of supply and transportation in France.^" Matters
arising under these two latter subjects included operations of the technical and
supply services, operations on the line of communications, and activities of the
transportation department. Studies and recommendations for the location
and character of railway and other establishments required for the transporta-
tion and service of our troops continued to come to this section for appro val.^^
The same was true with regard to all depot and hospitalization projects, includ-
ing not only the location of these installations, but also the storage capacity
of depots and the bed capacity of hospitals. Arrangements for the evacua-
tion of sick and wounded and orders for the original assignment of troops
arriving in France were also made in this section. In the course of time, how-
ever, as the armies began to take shape, the procedure involved in such assign-
ment became practically automatic.
By the middle of January, 1918, it became evident that some important,
if not radical, reorganization of general headquarters was necessary.^^ Accord-
ingly, on January 22, 1918, the following letter was sent by direction of the
commander in chief to the heads of all staff departments
1. General Orders No. 8, G. H. Q., A. E. F., 1917 (corrected), prescribing the distri-
bution of staff duties at these headquarters has been in operation long enough to give the
system a fair trial. While it is believed that the fundamental principles of the order are
generally sound, cases have arisen where there is an overlapping of functions. In some cases
experience may have shown that certain subjects have been incorrectly assigned or not
distinctly defined.
2. The principles of the order seem to be well understood by those primarily concerned
with its operation, but, on the other hand, it does not seem to be so drafted as to give a clear
presentation of the system to the outsider.
3. With a view of taking advantage of the experience thus far gained in the operation of
this order, it is desired that you submit, not later than February 5, a report with vour recom-
mendations embodjdng the following:
(a) What changes, if any, do you recommend for your own section or department?
INTRODUCTION
27
(6) What changes, if any, do you recommend in any section or department, other than
your own, which would facilitate the work of your section or department?
(c) Any suggestions which would make the order more clear to an outsider who has to
deal with the system.
(d) Any other suggestions or recommendations on the subject of organization of these
headquarters and the line of communications.
To the questions raised in the foregoing, the chief surgeon, A. E. F., under
date of February 4, 1918, replied as follows:
1. It is believed that the assignment of duties in tWs order so far as it concerns the Medi-
cal Department are substantially correct, and so far as can be ascertained there is no over-
lapping of functions. Some of the duties which were not exactly clear when the orders
were issued have been settled completely, and it is believed that the assignments are satis-
factory to the Medical Department at present. Since the order was issued much of the
technical work of the Medical Department has been assigned to the coordinating section of
the general staff instead of the administrative section. This is perfectly satisfactory to the
Medical Department. Frankly, it is believed to be a step in advance.
2. The chief surgeon is pleased to present certain recommendations in regard to the work
of his office:
(A) 1. Since headquarters have come to Chaumont, we have been handicapped in the
hospitalization section of this office by reason of the fact that our hospital construction is
done by the chief engineer, line of communications, and the running repairs and certain
materials for these hospitals are furnished by the chief quartermaster, line of communications,
and by further fact that we must correspond with those officers through their chiefs at these
headquarters. There has also been a delay in the transaction of business by reason of the
fact that investigation from this office of contemplated hospital sites and of construction, the
making of leases, etc., is diflRcult by reason of the great distance to many of our hospital-
ization sites. For this reason it is believed to be good administration to remove a part
of the hospitalization section from this office to the line of communications, and to request
authority to transact business with the chief engineer, line of communications, and the chief
quartermaster, line of communications, through this branch of the hospitalization service.
This, it is believed, will facilitate business and lessen to a great extent the necessary official
correspondence. This part of the hospitalization section can make a great many of the
inspections of contemplated hospital sites, inspections of construction, leases, etc., without
taking an officer from this office — a saving of time and mileage.
2. It is believed that the statistical section of the sanitary and statistical division (the
sick and wounded) of this office can be detached from this office without loss of efficiency.
In my opinion this section should be in Paris where it will be in close touch with the French
bureau of statistics where necessary data for American patients in French hospitals must
be obtained. If for any good and sufficient reason this location can not be approved it should
be separated from general headquarters and attached to chief surgeon's office, headquarters,
line of communications.
3. The time has come when the question of general sanitary inspectors for the American
Expeditionary Forces must l)e taken up. This subject has not been presented before,
because suitable officers were not available for this very important work. As officers with
the required cjualifications will soon arrive in France this question will be presented in a very
short time.
(B) 1. The coordinating section of the general staff is modeled after the fourth bureau
of the French War Department, but in accepting this organization, a very important part
of the fourth bureau, as far as the Medical Department is concerned, was omitted, namely.
Medical Department representation. The fourth bureau of the French War Department
works in a most satisfactory manner to its medical department for several medical officers
are constantly on duty at general headquarters with that bureau. I strongly urge that the
Medical Department be given representation on the general staff. It seems so clear that
this should be done that it is believed specific failures of coordination under the present
organization need not be presented. Moreover the time is rapidly approaching when the
demand for this representation will become more urgent.
28
ADMINISTRATION, AMERICAN EXPEDITIONARY ?T)R('ES
2. It is believed a part of the hospitalization section should be sent to the line of commu-
nication and that this office should be authorized to transact business direct through this
section with the chief engineer, line of communications, and chief ciuartermastcr, line of
communications, in regard to all cjuestions of approved hospitalization.
3. It is believed that the activities of the American Red Cross so far as they relate to
the Medical Department should be transacted through the coordinating section instead of
the administrative section of the general staff.
(C) 1. No suggestions to make under this heading.
(D) The following recommendations are made:
1. It is strongh^ urged that the Medical Department be given representation on the
general staff.
2. That an officer of the Medical Department be appointed liaison officer with the
French service de sante. Practically all the hospitals that we possess to-day in France
have been transferred to us by this service and ^ve have been greatly handicapped by not
having a liaison officer in the office of the sous-secretaire du service de sante. They consider
this of such great importance that they have repeatedly asked for this representation from
the Medical Department.
3. That the supervision of the activities of the American Red Cross so far as they relate
to the Medical Department be transferred from the administrative section to the coordinating
section, general staff.
4. That authority be given for the transfer of a unit of the hospitalization office to the
line of communications and that this office be authorized to conduct its correspondence
with the chief engineer, line of communications, and chief quartermaster, line of communi-
cations, on all approved projects through this unit.
5. That the statistical section of the sanitary and statistical division of this office be
transferred elsewhere.
6. That a statistical unit be stationed in Paris in close liaison with the statistical division
of the French War Department for the collection and transmission to Washington of the
sick and wounded data required by the Pension Bureau. This is believed to be necessary
by reason of the great number of sick we will have in French hospitals for many months
to come and by the further fact that we will also have in our hospitals many French patients.
A board appointed to meet and consider the replies of the various staff
chiefs met on February 8 and heard the chiefs of staff departments and other
interested officers. It reduced all views and suggestions to the following
questions :
(1) What changes, if any, should be made in the administration of supply in order to
reheve the commander in chief from the immediate direction thereof, and place direct and
complete responsibility therefor upon some competent authority?
(2) What changes, if any, should be made in the organization of the General Staff, in
order to insure greater efficiency and more harmonious relations?
(3) What further changes, if any, should be made as a result of the disposition of the
foregoing questions?
An analysis of the situation as developed by these inquiries was made with
a view of effecting necessary improvements. It was found that diversity of
opinion and practice existed among the different chiefs of the administrative
services with respect to the degree of personal responsibility assumed and
methods employed in details of supply; also, in decentralizing to secure a dis-
tribution of the heavy burdens of administration and the execution of the
tasks incident thereto, there had been an undesirable division of responsibility
and authority which at times led to uncertainty and hesitancy which might
prove disastrous in an emergency The analysis also indicated the immediate
necessity for providing a single and direct line of responsibility for all matters
INTRODUCTION
29
of supply with coincident full utilization of the services of the experienced chiefs
of the various administrative and supply departments. The board made a
number of important findings and recommendations, which were approved by
the commander in chief and given practical application by the publication of
General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918.'^ Other impor-
tant recommendations having been submitted later, a corrected copy of this
order was published March 13, 1918, but as of the date of the original.^^ Some
of its most important provisions may be mentioned here; e. g., control of com-
batant troops was separated from that of all supply departments and of miscel-
laneous organizations in rear of them, the whole American Expeditionary Forces
being divided into the zone of the armies and the Services of Supply (designated
in the first copy of this order as the Service of the Rear). Over the former,
comprising the organizations at the front (armies, corps, divisions, etc.) the
general staff exercised direct control while over the latter its control was indirect,
through the commanding general, Services of Supply. The general staff
remained at headquarters, A. E. F., at Chaumont, but headquarters of the
Services of Supply was located at Tours where it absorbed headquarters of the
preexisting line of communications.
The general staff was reconstructed as follows: A chief of staff, secretary
of the general staff, and five sections of the general staff, each under an assistant
chief of staff, were provided for, and among these specific duties were allocated.
The numerical designation of each section now corresponded closely to that of
the section of the French General Staff which was charged with similar duties.
Though this correspondence was incidental to the reorganization, it facilitated
the transaction of business between the two armies.
The administration section became the first section, the intelligence section
became the second, and the operations, coordination, and training sections
became, respectively, the third, fourth, and fifth sections of the general staff.
For convenience the names of the sections were abbreviated to G-1, G-2, and
so forth.
As to the duties assigned to these several sections it is sufficient here to
state that G-1 was charged, among other duties, with ocean tonnage, priority
of overseas shipments, replacements, organization, and equipment (in consulta-
tion with G-3) and with control of the American Red Cross, Young Men's
Christian Association, and similar agencies; G-2 was charged with procurement
of information, secret service, topography, and censorship; G-3 with operations,
liaison, general organization, and equipment; G-4 with supply, construction,
and transportation in France, statistics concerning the above, supply and
transportation for combat, hospitalization, and evacuation of the sick and
wounded, all operations of the Services of Supply not assigned to other sections
of the general staff and assignment of all new units arriving in France; G-5 was
charged with all activities pertaining to training, and it cooperated with the
third section in matters affecting organization and equipment.
As the first, fourth, and fifth sections of the general staff were now of
especial interest to the Medical Department, some further discussion concerning
them is deemed necessary.
It was not intended that the administrative section of the general staff
should directly control an}' of the supply bureaus, nor supplant the executive
30
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
heads of these important services, nor Hniit them in the exercise of their authority
in the internal administration of their own departments."^ The sole function
of this section of the general staff was to supervise the general policies of the
American Expeditionary Forces, in so far as this section was concerned, to
coordinate the activities of those departments and troops wliich were engaged
in the services of administration, supply, and evacuation, to preserve a just
balance between them, and to insure that their operations as a whole har-
monized with one another and w^ith the plans of campaign.
The fourth section of the general staff was the connecting link betw een the
general staff on the one hand and the Services of Supply on the other in all
matters affecting the Services of Supply w^hich were not assigned to other sec-
tions of the general staff. Its functions in maintaining intimate relations
between the office of the chief of staff, G. H. Q., and these various agencies in
the Services of Supply were both executive and advisory. It kept available
the latest information regarding supplies, state of construction, and efficiency
of rail transportation, studying and frequently reporting upon the practical
working of all technical staff and supply departments. Projects of any impor-
tance, especially those involving location of facilities, were examined by this
section to assure their harmony with the general scheme.^^ This section, which
had become of especial interest to the Medical Department after the publication
of Memorandum No. 129, H. A. E. F., 1917, which charged it, among other
duties, with, the provision of hospital facilities and the evacuation of sick and
wounded, continued to exercise jurisdiction over a larger number of the interests
of the Medical Department than did any other section of the general staff.^^
Its greatest importance to the Medical Department arose from its control of
policies and programs for hospitalization, storage, transportation and supply,
evacuation of wounded, assignment of units newly arriving in France, and staff
control of labor.^*'
Also, the fact that it was charged with supervision of all operations of the
Services of Supply, not assigned to other sections of the general staff, brought
under its control a number of other matters, in which the Medical Department
was interested.®^ Because of the importance to the Medical Department of the
American National Red Cross, particularly in matters pertaining to hospitaliza-
tion and supply, an effort was made to have control of this society transferred
to this section, but this was unsuccessful.®"
The fifth section, general staff, was charged with instruction and training
throughout the American Expeditionary Forces.®^ These included technical
training, preparation of manuals on that subject, promulgation of training
bulletins and courses of instruction, supervision of centers of instruction, and
staff schools. After the armistice was signed it was vested with control of edu-
cation, athletics, and entertainment.®^ This section w^as of especial interest to
the Medical Department through the supervision it exercised over the Army
sanitary school at Langres, the Joinville training area, where medical units
awaiting assignment were concentrated, and over the training of medical units
and detachments in divisional training areas.®^
After the reorganization prescribed by General Orders, No. 31, the general
staff continued to concern itself with the broader phases of control. Under the
13901—27. (Face p. 31.)
Fig. 1.— LilH■^^ of comnviinicfition, A. E. F., showing also the sections comprisinR the Sei vices of Supply
INTRODUCTION
31
supervision of the commander in chief and pursuant to clearly determined
policies, the assistant chiefs of staff at the head of their respective sections, sever-
ally coordinated by the chief of staff, issued instructions and gave general
direction to the great combat units and to the Services of Supply, keeping always
in close touch with the manner and promptness of compliance.^^ Thus a
system of direct responsibihty was put into operation which contemplated
secrecy in preparation, prompt decision in emergency, and coordinate action in
execution.^^ This supervision by the general staff included matters relating to
new troops and new equipment, excepting only such details as pertained to the
troops in the Services of Supply.''^ General headquarters, A. E. F., also retained
immediate control of military transportation and supply in the zone of the
armies and control of war material required in the conduct of military
operations.
The plans for operations of the Allies were communicated only to the com-
mander in chief and by him to a small number of higher staff officers under his
immediate command.^^ Arrangements for the employment of American troops
in conformity therewith were necessarily made at general headquarters, and
G-4 being responsible for supply and transportation arrangements for combat,
was obliged to keep in close touch with the Services of Supply in order that the
activities of that command might be fully coordinated with the prosecution of
the plans of the commander in chief.^'
The chiefs of the three purely administrative staff services were retained
with the general staff at general headquarters, which remained at Chaumont,
but the chiefs of the other staff departments were transferred to headquarters
of the Services of Supply at Tours.^^ The departments whose chiefs were re-
tained at general headquarters were those of the adjutant general, the inspector
general, and the judge advocate.
As previously stated, the jurisdiction known as the line of communications
was replaced by the Services of Supply.®^ The commanding officer of this
jurisdiction, whose headquarters remained at Tours and whose official status
remained unchanged, was charged with transportation, construction, territorial
command, and control of supply, sanitary, and telegraph service throughout the
territorial area of the Services of Supply. The Services of Supply was divided
for administrative purposes into an advance section, an intermediate section,
eight base sections in France, England, and Italy, the district of Paris, and the
Arrondissement of Tours. After the armistice was signed a ninth base
section was established with headquarters at Antwerp for the service of the
Third Army."^
While the chiefs of the purely administrative services (the adjutant general,
the inspector general and the judge advocate general) were retained with the
general staff at headquarters, A. E. F., at Chaumont, the chiefs of what were
now designated the "technical and administrative" staff departments, were
transferred to the headquarters of the Services of Supply at Tours.^^ The de-
partment whose chiefs were thus transferred were the following: The Quarter-
master Corps, Medical Corps, Corps of Engineers, Ordnance Department,
Signal Corps, Air Service, general purchasing board, Gas Service, service of
utilities (newly created by this order) and the provost marshal service. The
13901—27 3
32
ADMINISTRATION, ArVFEHICAN EXPEDITIONARY FORCES
chiefs of these staff departments retained their former duties and authority as
members of the staff of the commander in chief but exercised their duties in
matters of procurement, transportation, and construction and supply under the
direction of the commanding officer, Services of Supply, who coordinated their
activities in these matters. They were directed so to organize their offices that
the efficiency of their service would not be impaired by necessary absences for
conferences with the commander in chief or for other duty assigned them by
him.
Each was authorized and expected to travel throughout the American
Expeditionary Forces to supervise and direct the activities of his department in
all its elements, including combat units. The duties of these chiefs of staff
departments were therefore of a dual character. Thus the chief surgeon,
A. E. F., was, on the one hand, the chief surgeon of the Services of Supply,
supervising Medical Department activities throughout its area, and, on the
other, w^as the chief surgeon of all the American troops in Europe from the
Murman coast to Italy.
In so far as the Services of Supply is concerned, it is sufficient to state here
that the staff organization of that jurisdiction consisted of a general staff,
divided into four sections (later reduced to three), and of an administrative
staff whose departments rapidly increased in number.^^
Besides effecting the changes already mentioned, General Orders, No. 31,
G. H. Q., A. E. F., February 16, 1918, further directed that the distribution of
staff duties in army, corps, divisions, and other commands subordinate to
general headquarters, correspond in principle to that prescribed for general
headquarters. General Orders, No. 9, G. H. Q., A. E. F., January 15, 1918,
which had created the First Army had provided for that organization a chief
of staff, a general staff of 4 sections and 12 administrative and technical serv-
ices, but by General Orders, No. 120, G. H. Q., A. E. F., July 24, 1918, its
staff was made to consist of a chief of staff, 5 general staff sections, a chief of
artillery, and 13 administrative and technical services. The same organization
was prescribed for the Second Army, created by General Orders, No. 175,
G. H. Q., A. E. F., October 10, 1918, and for the Third Army, created by
General Orders, No. 198, G. H. Q., A. E. F., November 7, 1918, except that for
the last mentioned no tank service was provided.
The headquarters staff of the First Corps as organized by General Orders,
No. 9, G. FT. Q., A. E. F., January 15, 1918, consisted of a chief of staff, a
general staff of 4 sections (administrative, intelligence, operations, and training,
and coordination), and 12 administrative and technical services. The same
organization was prescribed for the Second, Third, and Fourth Corps by Gen-
eral Orders, No. 102, G. H. Q., A. E. F., June 25, 1918, but by General Orders,
No. 136, August 19, 1918, the organization of a corps was made to conform to
Tables of Organization 102, series B, War Department, corrected to April 20,
1918. Thereafter the headquarters staff of each corps consisted of a chief of
staff, 3 general staff sections (1, operations; 2, administration and coordination;
and 3, intelligence), and 12 administrative and technical services until a
thirteenth staff service (the motor transport) was added, by General Orders,
No. 219, G. H. Q., A. E. F., November 29, 1918. Similarly, the headquarters
INTRODUCTION
33
of an Infantry division as prescribed by Table 2, series A, Tables of Organiza-
tion, dated October 1, 1918, provided for a general staff with the same sections
as those authorized for the corps and for nine administrative and technical
staff departments.
The system of general staff control and subdivision prescribed for head-
quarters of the American Expeditionary Forces thus was applied to lower
echelons of the field forces, except that in corps and divisions, the fourth section
was merged with the first and the fifth section with the third. Control of
the field activities of the Medical Department which were vested in the fourth
section of the general staff at headquarters, A. E. F., was thus assigned to the
control of G-1 in corps and divisions — a circumstance which proved to be
undesirable and confusing.®*
REFERENCES
(1) List of militarj^ attaches. On file, Army War College (2279).
(2) Personnel cards of officers assigned as military observers, filed under the individual's
name. Card index. Army War College.
(3) Wadhams, Sanford H., Col., M. C, and Tuttle, Arnold D., Col., M. C: Some of the
Early Problems - of the Medical Department, American Expeditionary Forces.
The Military Surgeon, Washington, D. C, December, 1919, xlv, No. 6, 636.
(4) Instructions to military attaches, as of various dates. On file, Armv War College
(2279 and 8679).
(5) Memorandum from the Secretary of War, to the Secretary of State, August 12, 1914.
Subject: Military Observers. On file. Army War College (8679).
(6) Cablegram from the Military Attache, London, to the Secretary of War, August 17,
1914. On file. Army War College (8679).
(7) Based on card index, showing details to the Austrian Army. On file, Army War College.
(8) Cablegram from the Military Attach^, London, to Chief of the War College Division,
General Staff, August 19, 1914. On file. Army War College (8679).
(9) Memorandum from the Chief of Staff, to the Surgeon General, August 12, 1914, Subject
Medical Officers as Observers. On file, Record Room, S. G. O., 150021 (Old Files).
(10) Letter from The Adjutant General, to Maj. J. H. Ford, M. C, September 1, 1914.
Subject: Detail as military observer. On file, Commissioned Personnel Division,
S. G. O.
(11) Special Orders No. 250, War Department, October 27, 1915. Paragraph 15.
(12) Telegram from Assistant Secretary of War, to American Ambassador, Paris, September
9, 1914. On file, Commissioned Personnel Division, S. G. O.
(13) Letter from the chief of the War College Division, General Staff, to the Surgeon General-
January 15, 1915. Subject: Report of Maj. P. L. Boyer, M. C, from September
12, 1914, to November 23, 1914. On file. Record Room, S. G. O. 150021 (Old Files) .
(14) Letter from Sir William Osier, to the President of the United States, Woodrow Wilson,
January 30, 1916. Subject: Detail Medical Officers. On file. Army War College
(8679).
(15) Memorandum from the Surgeon General, to the Chief of Staff, March 6, 1916. Subject:
Submitting names of officers. On file. Record Room, S. G. O. (150021).
(16) Letter order from The Adjutant General, to the Surgeon General, April 10, 1916.
Subject: Assignment of Lieut. Col. A. E. Bradley, M. C, Maj. Clyde S. Ford,
M. C, and Maj. W. J. L. Lyster, M. C. On file, Commissioned Personnel Division,
S. G. O.
(17) Based on card index, showing details to the German Army. On file, Army War College.
(18) Letter from Col. A. E. Bradley, M. C, to the Surgeon General, June 11, 1917. Subject:
Medical personnel serving with British Forces. On file, Record Room, S. G. O.,
9795 (Old Files).
34 ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
(19) Letter orders from The Adjutant General, to Col. A. E. Bradley, M. C, and Maj.
Clyde S. Ford, M. C, May 29, 1917. Subject: Assignments. On file, Record
Room, S. G. O., 9795 (Old Files).
(20) Personal report of Maj. W. J. L. Lyster, M. C, to the Surgeon General, June 30, 1917.
On file, Commissioned Personnel Division, S. G. O.
(21) Telegram from chief of staff, A. E. F., to Maj. W. J. L. Lyster, M. C, Paris, June 9,
1917. On file, Record Room, S. G. O., 9795 (Old Files).
(22) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, liaison officer,
London, June 25, 1917. Subject: Instructions. The administration of American
medical personnel with the British in relation to the A. E. F. On file. Record Room,
S. G. O., 76278 (Old Files).
(23) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., June 21,
1917. Subject: Report of personnel of chief surgeon's office. On file, A. G. O.,
World War Division, chief surgeon's files, 321.6.
(24) Special Orders No. 26, Headquarters, A. E. F., July 4, 1917. Paragraph 2. On file,
A. G. O., World War Division, A. E. F. Records, Special Orders.
(25) Letter from the British War Office, to the American Ambassador, London, February 23,
1917. Subject: Veterinary observer. On file, x\rmy War College, 6467.
(26) Letter from The Adjutant General, to Veterinarian William P. Hill, 6th Field Artillery,
December 27, 1915. Subject: Detail. On file, Army War College, 9244.
(27) Letter from The Adjutant General to Veterinarian William P. Hill, March 10, 1917.
Subject: Orders. On file, A. G. O., 2547294 (Old Files).
(28) Special Orders, No. 7, Headquarters, A. E. F., Paris, June 14, 1917. Paragraph 1.
On file, A. G. O., World War Division, A. E. F. Records, Special Orders.
(29) Letter from Chief of War College Division, General Staff, to the Surgeon General,
June 5, 1915. Subject: Detail of medical observer with French armies. On file,
Record Room, S. G. O., 150021 (Old Files).
(30) Second indorsement from the Surgeon General to The Adjutant General, June 12, 1915,
on letter from Chief of War College Division, General Staff, to the Surgeon General,
June 5, 1915. Subject: Detail medical observer with French armies. On file,
Record Room, S. G. O., 150021 (Old Files).
(31) Letter Order from The Adjutant General to Maj. James R. Church, M. C, November
15, 1915. Subject: Detail. On file, Commissioned Personnel Division, S. G. O.
(32) Letter from the Secretary of State to the Secretary of War, September 1, 1916. Subject:
Request medical officer visit prisoners of war in France. On file, Record Room,
S. G. O., 150021 (Old Files).
(33) Second indorsement from the Surgeon General to The Adjutant General, September
12, 1916, on letter from the Secretary of State to Secretary of War, September 1,
1916. Subject: Request medical ofl^icer visit prisoners of war in France. On file,
Record Room, S. G. O., 150021 (Old Files).
(34) Letter from The Adjutant General to Maj. S. H. Wadhams, M. C, September 25, 1916.
Subject: Detail as military observer. On file, Record Room, S. G. O., 76283 (Old
Files).
(35) Letter from Acting Chief, War College Division, General Staff, to Maj. S. H. Wadhams,
M. C, January 10, 1917. Subject: Detail. On file, Record Room, S. G. O., 76283
(Old Files).
(36) Letter from Maj. James Robb Church, M. C, Maj. James A. Logan, jr., Q. M. C, Capt.
J. M. Barker, 3d Inf., Capt. Frank Parker, 11th Cav., Capt. M. Churchill, Field
Art., Veterinarian W^m. P. Hill, 6th Field Art., to Chief, War College Division,
General Staff, July 19, 1916. Subject: Recommendation as to organization of
militarj^ observers. On file, Army War College (8679).
(37) Letter from Acting Chief of War College Division, General Staff, to Maj. James A.
Logan, jr., Q. M. C, Paris, November 21, 1916. Subject: Organization of military
mission. On file. Army War College (8679).
• (38) Letter from the chief of the American military mission, Paris, to the Chief of the War
College, General Staff, February 14, 1917. Subject: Increased opportunities for
military observers. On file. Army War College (8719).
INTRODUCTION
35
(39) Letter from officer in charge of military intelligence to Col. A. E. Bradley, M. C,
Maj. Clyde S. Ford, M. C, Maj. W. J. L. Lyster, M. C, Maj. Sanford H. Wadhams,
M. C, and Maj. James A. Logan, jr., Q. M. C, February 10, 1917. Subject: Medico-
military information. On file. Army War College (8679).
'^10) Memorandum from Chief of the War College Division, General Staff, to the Chief of
Staff, June 9, 1917. Subject: Ports of debarkation. On file. Army War College,
10132.
(41) Report from chief of medical group to assistant chief of staff, 4th section of general
staff, December 31, 1918. Subject: Activities of medical group, 4th section, general,
staff, General Headquarters, A. E. F. Copy on file, Historical Division, S. G. O.
(42) Cablegram from the Chief of Staff to Maj. James A. Logan, jr., Q. M. C, June 5,
1917, Subject: Reporting to General Pershing. On file. Army War College (10050)
(43) Letter from the Surgeon General to The Adjutant General, October 18, 1916. Subject:
Detail. On file, Record Room, S. G. O. 104882 (Old Files).
(44) Special Orders No. 244, War Department, October 18, 1916. Paragraph 21. On file,
Commissioned Personnel Division, S. G. O.
(45) Telegram from the Surgeon General to Maj. Robert M. Culler, M. C, October 27,
1916. On file. Record Room, S. G. O., 104882 (Old Files).
(46) Special Orders No. 105, War Department, May 7, 1917. On file. Record Room,
S. G. O., 104882 (Old Files).
(47) Letter from the Surgeon General to Mr. L. Jouvard, president of French Benevolent
Society, French Hospital, New York City, May 22, 1917. Subject: Major Culler's
status. On file. Record Room, S. G. O., 104882 (Old Files).
(48) Special Orders, No. 115, Headquarters, A. E. F., October 3, 1917. Paragraph 6.
(49) Special Orders, No. 60, Headquarters, Line of Communications, A. E. F., October 7,
1917.
(50) Personal report from Maj. William L. Keller, M. C, to the Surgeon General, April 3,
1923. On file. Commissioned Personnel Division, S. G. O.
(51) Special Orders, No. 105, War Department, May 7, 1917. Paragraph 28.
(52) Special Orders, No. 66, Headquarters, A. E. F., March 7, 1918. Paragraph 48.
(53) Special Orders, No. 81, War Department, April 9, 1917. Paragraph 17.
(54) Special Orders, No. 81, War Department, April 9, 1917. Paragraph 18.
(55) Telegram from The Adjutant General, to Superintendent, U. S. Military Academy,
West Point, N. Y., April 7, 1917. Copy on file. Record Room, S. G. O., 128346
(Old Files).
(56) Special Orders, No. 105, War Department, May 7, 1917. Paragraph 28.
(57) Special Orders, No. 28, Headquarters, A. E. F., July 6, 1917. Paragraph 9.
(58) Special Orders, No. 68, Headquarters, A. E. F., August 15, 1917. Paragraph 11.
(59) Annual Report of the Surgeon General, U. S. Army, 1916, 18-19; 1917, 22.
(60) Report from Col. Percy L. Jones, M. C, Chief of the U. S. Army Ambulance Service
with the French Army, to the Surgeon General, U. S. Army, April 15, 1919. Subject:
U. S. Army Ambulance Service with the French Army. On file, Historical Division,
S. G. O.
(61) Memorandum from Col. Jefferson R. Kean, M. C, to the Surgeon General, April 4,
1917. Subject: Organization of base hospitals. On file, Record Room, S. G. O.,
15542 (Old Files).
(62) Report on origin and organization of base hospitals and other sanitary units (undated)
by Col. Jefferson R. Kean, M. C. On file. Historical Division, S. G. O.
(63) Xetter from Col. A. E. Bradley, M. C, A. E. F., to the Surgeon General, June 11, 1917.
*" Subject: Medical personnel serving with British forces. On file, Record Room,
S. G. O., 9795 (Old Files) ; also, telegram from the Surgeon General to Maj. Robert M.
Culler, M. C, October 27, 1916. On file, Record Room, S. G. O., 104882 (Old Files);
also, personal report from Maj. William L. Keller, to the Surgeon General, April 3,
1923. On file, Historical Division, S. G. O.; also. Special Orders No. 81, War
Department, April 9, 1917.
36 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(64) Letter from the Surgeon General to the Chief of Staff. May 1, 1917. Subject: Memo-
randum from Col. T. H. Goodwin, R. A. M. C. Copy on file, Record Room, S. G.
O., 172158 (Old Files).
(65) Report from the chief surgeon, A. E. F., to secretary, general staff, A. E. F., May 31,
1918. Subject: The Medical Department in the A. E. F. to May 31, 1918. Copy
on file. Historical Division, S. G. O.
(66) Letter from the Surgeon General to The Adjutant General, May 1, 1917. Subject:
Medical officer for duty in Euorpe. Copy on file. Record Room, S. G. O., 172158
(Old Files).
(67) Report of Base Hospital No. 21 (not dated) by Maj. Walter Fischel, M. C. On file.
Historical Division, S. G. O.
(68) Cablegram from the miUtary attach^ at London, to the Surgeon General, May 21,
1917. On file, A. G. O., World War Division, chief surgeon's files, 201 (Bradley,
A. E.).
(69) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, American
Embassy, London, June 11, 1917. Subject: Administration of American medical
personnel serving with British Forces. On file. Record Room, S. G. O. 9795 (Old
Files) .
(70) Letter from The Adjutant General to Col. A. E. Bradley, M. C, May 28, 1918. Sub-
ject: Designation as chief surgeon, U. S. Forces in Europe. On file, A. G. 0.,
World War Division, chief surgeon's files, 201 (Bradley, A. E.).
(71) Final report of Gen. John J. Pershing, September 1, 1919, 11.
(72) Report from the assistant chief of staff, fourth section, general staff, General Head-
quarters, A. E. F., to the chief of staff, A. E. F., June 1, 1919, 12. On file. General
Headquarters, A. E. F. Records.
(73) Report from the assistant chief of staff, Fourth Section, G. H. Q., A. E. F., 11.
(74) General Orders, No. 8, General Headquarters, A. E. F., July 5, 1917 (corrected copy).
(75) Tables of Organization No. 1, Series "A," W. D., August 27, 1918.
(76) Tables of Organization No. 28, Series "A," W. D., April 17, 1918.
(77) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, to May 1, 1919. On file
Historical Division, S. G. O.
(78) Medical History of the 41st Division (undated). On file. Historical Division, S. G. 0.
(79) Report from Col. S. H. Wadhams, M. C, chief of medical group, fourth section, gen-
eral staff. General Headquarters, A. E. F., to chief of fourth section, general staff,
Headquarters, A. E. F., December 31, 1918, 17. Copy on file. Historical Division,
S. G. O.
(80) Organization of the Services of Supply, A. E. F., Monograph No. 7, prepared by
Historical Branch, War Plans Division, General Staff, June, 1921, Washington,
Government Printing Office. War Department, Document No. 1009, 17.
(81) Final report of Gen. John J. Pershing, September 1, 1919, S.
(82) Memorandum from Gen. John J. Pershing, to The Adjutant General, U. S. Army,
September 18, 1917. Subject: Service of the Rear and Line of Communications.
On file, General Headquarters, A. E. F. Records.
(83) Memorandum from the commander in chief to The Adjutant General, U. S. Armv,
October 7, 1917. Subject: Priority of shipment (personnel). On file. General
Headquarters, A. E. F. Records.
(84) General Orders, No. 40, G. H. Q., A. E. F., September 20, 1917.
(85) Organization of the Services of Supply, A. E. F., Monograph No. 7, 19.
(86) Statement based on the final report of General Pershing, September 1, 1919, and report
of the assistant chief of staff, fourth section, general staff. General Headquarters,
A. E. F.. to the chief of staff, June 1, 1919. On file. General Headquarters, A. E. I- '
Records. '
(87) Minutes of the Allied Maritime Transport Council, September 27 1918 On file
Historical Branch, War Plans Division, General Staff.
(88) Final report of Gen. John J. Pershing, 90.
INTRODUCTION
37
(89) Report from the assistant chief of staff, fourth section, G. H. Q., A. E. F., appendix "J."
(90) Ibid., 15.
(91) Ibid., 16.
(92) Letter from commander in chief, to chiefs of staff departments, A. E. F., January 22,
1918. Subject: Reorganization. On file, A. G. O., World War Division, chief
surgeon's file, A. E. F. (321.6).
(93) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., February
4, 1918. Subject: Reorganization. On file, A. G. O., World War Division, chief
surgeon's file, A. E. F. (321.6).
(94) Report from the chief surgeon, A. E. F., to the commanding general, S. O. S., A. E. F.,
July 1, 1918. Subject: The medical department in the A. E. F., to May 31, 1918.
Copy on file, Historical Division, S. G. O.
(95) General Orders No. 31, General Headquarters, A. E. F., February 16, 1918.
(96) Final report of Gen. John J. Pershing, September 1, 1919, 12.
(97) Ibid., 68.
(98) Organization of the Services of Supph', A. E. F., Monograph No. 7, 25.
(99) Reports from the assistant chief of staff, fourth section. General Headquarters,
A. E. F., 22.
SECTION I
ORGANIZATION AND ADMINISTRATION OF THE CHIEF
SURGEON'S OFFICE
CHAPTER I
GENERAL ORGANIZATION AND DEVELOPMENT
On May 10, 1917, the Surgeon General wrote The Adjutant General of
the Army as follows: ^
I recommend:
That Col. Alfred E. Bradle}- , Medical Corps, in addition to his present duties as observer
with the English Army, be designated as chief surgeon United States forces in Europe.
That, as chief surgeon of United States forces in Europe, Colonel Bradlej^ be authorized
to exercise over the forces under his control the same authority as the Surgeon General
holds over the entire Medical Department. Similar authority was granted, on the approval
of the Secretary of War February 18, 1899, to the chief surgeon of the Department of the
Pacific and Eighth Army Corps (now the Philippine Department) .
In conformity with the foregoing request, The Adjutant General wrote to
the officer in question, on May 28, as follows: ^
The Secretary of War designates you, in addition to your present duties as chief surgeon,
United States forces in Europe.
The Secretary authorizes you, as chief surgeon of the United States forces, to exercise
over the forces under your control the same authority as the Surgeon General holds over the
entire Medical Department.
Meanwhile, on May 26, 1917, this officer had been designated chief surgeon
of the American Expeditionary Forces in General Orders, No. 1, of that organi-
zation, which was published in Washington, D. C, but neither the foregoing
letter nor a copy of the order mentioned was received by him prior to the
arrival of headquarters, A. E. F., in London, on June 9, 1917.^
The Medical Department personnel which accompanied the commander
in chief consisted of 4 officers, 2 enlisted men, and 4 civilian clerks.* On
arrival in London they were joined by the chief surgeon, who had been serving
as military observer with the British, but who, on May 29, had been relieved
from that assignment.^ One of his first duties as chief surgeon, A. E. F., was
the formulation of instructions for the liaison officer for the Medical Depart-
ment with the British, who also had been serving as a military observer and
who was now charged with supervision of the base hospitals and casual per-
sonnel of the American Expeditionary Forces which were under British control.^
On June 13, headquarters, A. E. F., moved to Paris,^ where, by the 17th,
it was joined by three other medical officers who had been serving as military
observers with the French or British forces.^ When headquarters, A. E. F.,
established itself in Paris the chief surgeon's office force, now consisting of
39
PLATE I
PLATE 2
42
ADMIXISTHATIOX, AMERICAX EXPEDITIONARY FORCES
seven medical officers and about twice that number of clerks, was located,
with other bureaus, in a small residential building where it occupied three
small rooms. ^ Almost immediately the chief surgeon and certain members of
his staflf began tours of inspection in order to determine matters concernmg
hospitalization at base ports and along the line of communications.^" On
July 4, a medical officer was relieved from duty in the chief surgeon's office
and assigned as surgeon of base section No. 1 (St. Nazaire), w-here the first
contingent of troops was expected to debark.
When the staff of the American Expeditionary Forces was organized
and its several duties were defined by General Orders, No. 8, Headquarters,
A. E. F., July 8, 1917, the functions assigned to the Medical Department
were as follows:
Sanitation of camps, quarters, and occupied territory; health of command; care of sick
and wounded; collection and evacuation of sick and wounded; medical personnel; medical
supplies; veterinary personnel; veterinary supplies; laundries and baths (medical aspect);
disinfection of clothing, etc.; supply of personnel and material for gas defensive under super-
vision of director of gas service; technical inspection of medical organizations and estab-
lishments, etc., etc.
Until the administrative structure of the American Expeditionary Forces
was radically changed, as noted in the preceding chapter, by General Orders,
No. 31, General Headquarters, A. E. F., February 18, 1918, the staff organi-
zation in general was comparable to that existing in the War Department.
The relationship of the chief surgeon's office to the general staff and to the
chiefs of administrative staffs was similar to that existing between the Surgeon
General's office, on the one hand, and the General Staff and the several bureaus
of the War Department, on the other."
Until the American Expeditionary Forces w^as reorganized by the order
mentioned the chief surgeon w^as located at headquarters with the general
staff and the chiefs of other administrative staff departments, and he or his
assistants, therefore, were enabled to transact business directly with the staff
offices concerned.
As the general staff w^as charged with approval and coordination of all
policies and projects for the American Expeditionary Forces the chief surgeon
or his assistants took up directly with appropriate sections of that body all
matters pertaining to the medical service which required its authoritization,
coordination, or execution.
The more important policies usually were placed on record and then dis-
cussed verbally. 12 It was quickly realized that very close cooperation of all
elements was necessary at general headquarters and that only through cen-
tralized control could prompt results be secured conforming to changing con-
ditions.** Careful studies w^ere made of future needs and these after being
approved by the general staff, w^ere cabled to the United States. «
Communication between the chief surgeon's office and that of the Surgeon
General was carried on by letter direct, or, if circumstances required, through
official channels, or by cable. Communications cabled from one office to the
other passed through the respective cable offices in headquarters, A. E. F., and in
° Such relationship is described in Volume I of this history.—
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 43
the War Department. Copies of cables which the chief surgeon's office
wished to send were submitted to the adjutant general, A. E. F., if they
pertained to administrative matters, or if to other matters, to the Chief of Staff
who referred them for examination to the appropriate section of the General
Staff. A section in the office of the adjutant general edited all cables for
clearness, arranged them for logical sequence with previous telegrams, and
incorporated them with drafts of other cables on the same subject from other
departments into one long message signed, "Pershing." The avenues for
transaction of business with the medical service of the Allies are discussed in
Chapter III.
After the arrival of headquarters of the 1st Division on June 26, 1917, and
that of considerable casual personnel, the work of the chief surgeon's office had so
multipled that the office space in headquarters, A. E. F., had become over-
taxed.® Therefore, about the middle of July that office, with some other
special branches of the headquarters group, moved to more commodious
in the Hotel St. Anne, in the street of that name.*
Here some of the more important policies of the Medical Department
were developed and adopted and considerable creative and constructive work
was accomplished.® Problems which arose during the earlier stages of the
American Expeditionary Forces when headquarters was located at Paris, and
later at Chaumont, included determination of general policies, such as location
and size of hospitals, percentage of hospital beds to total strength of the Ameri-
can Expeditionary Forces; estimates of quota, distribution and training of
personnel; amount and character of Medical Department supplies required;
relative priority of Medical Department personnel and supplies in shipments
from the United States; the tonnage such supplies would require; character and
quantities of supplies that could be procured advantageously overseas; size and
location of storage depots; provision of hospital trains; arrangements for care
of casualties at the front, for their removal from the lines, distribution and
treatment in the rear, and, if need be, sending them home; organization of gas
defense; standardization of splints; provision of agencies for transaction with the
Allies of business which was of mutual interest, e. g., procurement of sites for
hospitals and other installations; procurement of facilities from or through the
American Red Cross; control of infectious diseases, especially of venereal
diseases; organization of the laboratory system and of the professional services;
and many cognate subjects.'^ These policies of the Medical Department were
determined at conferences attended by the few medical officers available at
headquarters, or at more general conferences in which representatives of the
Medical Department participated with those of other staff departments of the
American Expeditionary Forces or with representatives of the French Army.®
A long step toward decentralization of medical service was taken when a
chief surgeon was designated for the line of communications.'® The necessity
for such an organization arose when the 1st Division arrived in July, and moved
to its training area in the Vosges. The geographical limits of the line of com-
munications extended from the sea to the point where supplies were delivered
to the field transportation of the combat forces less such areas as might be
excepted. Headquarters of this jurisdiction, while undergoing organization,
was located in Paris, whence it moved January 13, 1918, to Tours.®
44
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
A colonel, Medical Corps, who arrived with a small force on July 18 was
assigned as chief surgeon, line of communications,'^ and was vested with immedi-
ate supervision of Medical Department personnel and transportation, base
hospitals, sanitation, and suppHes, in its jurisdiction. As his office was
located in the same building as that occupied by the chief surgeon, A. E. F .,
numerous conferences occurred between their representatives'® until September
1, when the latter's office moved with headquarters, A. E. F., to Chaumont.''
A medical supply officer for the American Expeditionary Forces arrived
on July 20 and proceeded to the base medical supply depot being established
at Cosne.'^ As additional personnel was now^ necessary in the office of the
chief surgeon, A. E. F., and that of the chief surgeon of the line of communica-
tions the adjutants of the six American base hospitals already serving with the
British (as mentioned in Chapter I) were relieved from duty therewith and
ordered to Paris, where two of them were assigned to the office of the chief
surgeon, A. E. F., and four to the office of the surgeon, line of communications.*
Also an American medical officer who had been serving at a French hospital at
Ris Orangis and one who had been studying the organization of gas warfare
in England were ordered to join the office of the chief surgeon, A. E. F.^°
Until the latter part of Juh^, 1917, the chief surgeon's office, A. E. F., had
not been divided into sections and none of its personnel had been assigned to
particular duties exclusively.'^ Nearly all of the work transacted had been of
a character which required determination of broad general policies which were
part of or conformed to the three important basic projects of the American
Expeditionary Forces discussed in the preceding chapter.
As troops began to arrive in increasing numbers, more specific alloca-
tion of duties became necessary in the chief surgeon's office, in order that proper
action might be taken promptly both on routine reports and on a number of
diversified matters.'' For example, base hospitals which were arriving con-
stantly had to be promptly and suitably located, arrangements had to be made
with the French for the care or evacuation of American sick until our Medical
Department establishments could care for them, the considerable numbers of
casual personnel who were arriving had to be suitably classified and assigned,
and many questions of policy on a w^ide range of subjects were now pressing
for decision.^
After the arrival of a number of casual medical ofiicers in the latter part
of July the chief surgeon's office, A. E. F., was organized on the 28th of that
month, as follows :
(1) An executive officer, who assisted the chief surgeon in supervision and coordination
of the sections of his office, represented him when absent at conferences or on tours of inspec-
tion, and under the chief surgeon was in general charge of the administration of the medical
service, A. E. F.
(2) Hospitalization.— In charge of location, construction, and repair and all other ques-
tions relating to hospitals; hospital trains; and the care of sick and wounded.
(3) Sanitation and statistics. — Sanitation of camps, quarters, and occupied territory,
laundries, disinfection and disinfestation, collection and evacuation of sick, health of com-
mand, reports of sick and wounded, statistics and sanitary reports.
(4) Personnel— Medical, Medical Reserve, Dental, and Veterinary Corps, enlisted force,
schools of instruction, and civilian emploj^ees. '
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 45
(5) Supplies. — Hospital equipment, medical, dental, and veterinary supplies, settlement
of accounts, ambulances, and all motor transportation.
(6) Records and correspondence.
(7) Chemical Warfare Service. — Defensive gas, gas school, and all professional questions
relating to gas.
There was but one officer on duty with each of the sections mentioned above
except that the head of the hospitalization section (who was also charged with
Franco-American liaison which is discussed in Chapter III) had a commissioned
assistant.^ These officers also handled general estimates of personnel and
equipment.^ Associated with this headquarters group was another officer who
had been designated attending surgeon.^
During the week ending August 4, 1917, a liaison officer was appointed to
function between the Medical Department and the coordination section of the
general staff, an innovation which it was anticipated would greatly promote
transaction of business between the two offices.
The chief surgeon was also represented by a liaison officer at the head-
quarters of the American Red Cross and of the Young Men's Christian Associa-
tion in Paris. He also maintained close contact with the other societies serving
the American Expeditionary Forces and availed himself of their cooperation as
circumstances indicated.
So much of the American Red Cross in Europe as was called into the service
of the American Expeditionary Forces came under the immediate jurisdiction
of the chief surgeon, A. E. F., though in the last analysis that and other hke
societies serving the American Expeditionary Forces were under the control of
the first section of the general staff The activities of the American Red Cross
in the military service were quite diversified, but in very general terms they
pertained especially to hospitilization and medical supply.
On August 23 a dental officer was assigned to duty in the chief surgeon's
office and began, in the personnel division, the organization of the dental
service of the American Expeditionary Forces.^*
After the chief surgeon's office had been moved from Paris to Chaumont,
September 1, 1917, in the zone of the armies, it occupied the upper floors in the
west end of the south barracks at that place. The floor space allotted here
to the chief surgeon's office was many times as great as that which had just
been vacated in Paris, for it was appreciated that a large increase in its personnel
would soon be necessary.^ The chief surgeon's office when established in
Chaumont included 10 commissioned officers of the Medical Department."
Before leaving Paris, 4 officers were detached to remain in that city, 1 with the
water service of the line of communications, 2 as liaison officers with the Ameri-
can Red Cross and the Young Men's Christian Association, respectively, and
1 who served both as the medical member of the general purchasing board,
A. E. F., and later as liaison officer with the French Medical Department."
The Chemical Warfare Service was established as a separate bureau by
General Orders, No. 31, G. H. Q., A. E. F., September 3, 1917, and to this a
medical officer in close touch with the chief surgeon's office was later assigned.
On September 13, 1917, the chief surgeon was directed to submit at as
early a date as practicable a project for the Medical Department for the next
46
ADMIXISTRATIOX, AMEHICAX EXPEDITIOXAK Y FORCES
six months covering the proposed location of medical depots, laboratories,
hospitals, other establishments, and sanitary units, and his project for supplies
and material.
On October 9, 1917, the chief surgeon submitted the following plan of
organization of his office and that of the army surgeon at army headquarters
in the field: "
Fig 2.-M-ing B of group of three iiiaiii buildings, general headquarters, A. E. F., in which the ofRce of the chief surgeon
^roup, geSftafl!°I ^'""^ subsequently, of the Sai
Chief surgeon
Assistant to chief surgeon
Personnel division
Sanitation and statistics
Records and correspondence
Hospitals, construction and assignment
Supplies
Major
general
Total.
Briga-
dier
general
Colonel
Lieuten-
ant
colonel
Major
Captain
or lieu-
tenant
Clerks
or
soldiers
22
.50
80
100
3
Dental and veterinary service to be represented in this personnel section by an officer
ot the highest rank in these corps.
1 brigadier general.
1 colonel.
1 lieutenant colonel.
FOR ARMY HEADQUARTERS
1 major.
7 soldiers.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 47
In reply to a communication from the adjutant general, the chief surgeon,
on November 7, 1917, submitted the following statement of the subdivision of
duties in his office, and of the personnel that would be requu-ed to staff them,,
viz, chief surgeon (1 officer), assistant to chief surgeon (1 officer), personnel
division (5 officers, including 1 dental and 1 veterinary, and 22 clerks), sani-
tation and statistics (3 officers and 50 clerks), records and correspondence
(1 officer and 80 clerks), hospital construction and administration (6 officers
and 100 clerks), supplies (1 officer and 3 clerks).-*
On November 13, 1917, a chief nurse of the American Expeditionary Forces
was designated and was assigned, with an assistant, to duty in the office of the
chief surgeon, line of communications. She and her assistant were not incor-
porated in the office of the chief surgeon, A. E. F., until it moved to Tours.
This designation of the chief nurse later was changed to "director of nursing
service," but her duties remained unchanged.
The fofiowing data concerning the chief surgeon's office formed a part of
the table of organization for headquarters, A. E. F., office of the commander
in chief, approved by General Pershing on December 22, 1917:
Tables of organization, general headquarters, A. E. F.
CHIEF SURGEON'S SECTION
1
2
3
4
5
6
7
Remarks
Unit
OflBcers
Inter-
preters
Clerks
Sol-
diers '
Sol-
diers <•
Total
1
3
5
9
12
2
General officer
1
3
5
9
12
(o) Carried in headquarters battalion.
(6) 1 chauffeur, 1 orderly for general
officer.
(c) All from Medical Department but
attached to headquarters battalion for
rations, pay, and clothing.
(d) Clerks.
(e) 3 chauffeurs, 5 clerks.
(/) 5 motorcyclists, 5 chauffeurs.
ig) Pistols for 9 chauffeurs, 5 motor-
cyclists, 15 orderlies.
f
Colonels
Lieutenant colonels
Majors
Captains or lieutenants
Commissioned interpreters
2
Total commissioned. -
Field clerks
30
2
32
5
5
M. H. sergeants
5
5
5
5
5
25
58
28
73
52
Hospital sergeants
Sergeants major or bat-
talion sergeants major
Sergeants, first class
25
52
20
63
40
Sergeants
o 4
h 2
•8
no
* 5, 12
Corporals
Privates, first class
Privates
Total enlisted _
4
210
37
251
Aggregate
30
5
210
37
288
Closed cars.— _
1
3
5
1
3
5
2
3
5
15
29
Touring cars
Light cars
Motor cycles, with side cars
2
3
5
5
' 29
Horses, riding
10
Pistols
RED GROSS SECTION (SERVICES VOLUNTEERED)
1
2
3
4
Remarks
Unit
Officers
Others
Total
Captain -
1
1
Total commissioned
Not commissioned ..-
1
I
1
1
Aggregate-- -
1
I
2
1
1
13901—27 4
48
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
With the development of the American Expeditionary Forres, decentraliza-
tion had been necessary in practically every department. This movement was
investigated and the following report on this subject in so far as it pertained to
the chief surgeon's office w^as forwarded to it by the adjutant general, A. E. F.,
on January 10, 1918:=^'
Statement of organization and personnel
Division
Officers
1
•5
5
2
2
2
2
2
Clerks
Soldiers
MO
3
2
10
18
9
2
4
21
4
54
"»Two Veterinary Corps (temporary duty). ''Sorting mail.-
Personnel division. — This division keeps record of all the personnel of the Medical Corps,
regular or otherwise, hospital corps sergeants, and nurses, on duty in France. Most of the
records concerning personnel are kept on cards; these cards give name of college, date of
graduating; whether medicine, dental or veterinary surgery; previous military service and
date of appointment and call into active service; and special character of professional work;
also specialty and ability to speak or translate French. These cards are made out in cases
of all Medical Reserve Corps men. All medical personnel arriving in France are now
assigned to duty from this office. When the system of automatic replacements is put into
effect this work should be decentralized to the line of communication .
Hospitalization. — This division handles all questions relating to the establishing of hospi-
tals in France. The selection of sites are passed upon by the general staff at these headquarters
after conference with the French mission. It is not seen how this can be divorced from the
office of the chief surgeon. The actual building and plans, etc., are now decentralized to the
line of communications.
Sanitation and statistics. — All reports concerning sanitation, sick and wounded, etc., from
the medical sections of all units come to this office. Statistics and reports are made up
concerning them; also the weekly report to the commander in chief. If the statistical bureau
is established at these and other headquarters, it is believed with representative of the Medical
Department serving thereat that most sanitary reports and reports of sick and wounded
could come to this bureau.
There is a certain amount of data though which should, in my opinion, come to the chief
surgeon, who after all is responsible for the evacuation of sick and wounded and their care, and
it is beheved that in case of heavy casualties or epidemic the chief surgeon at these head-
quarters should receive the necessary data in order to enable him to understand the situation.
Practically, the evacuation of sick and wounded will be automatic, but in times of emergency,
the chief surgeon may have to act and exercise supervision over situations, and he must be
kept informed as to the general situation. It is not necessary for him to have all the informa-
tion in detail that is required for final reports to Washington. Data required for furnishing
reports to the commander in chief should come to the statistical bureau at these headquarters.
Others which are only required for the chief surgeon's office in Washington could be sent to
the statistical bureau at the headquarters, line of communications, it is believed.
Records and correspondence. — When the automatic replacement is put into effect much of
the records and correspondence work will naturally go from the chief surgeon's office to the
depots of the line of communications.
There is a post office here in which is distributed all the mail for the personnel of the Medical
Department serving in France. It is recommended that immediate steps be taken to have
the mail distributed elsewhere, and that only mail for the personnel on duty in the Medical
Department at these headquarters be forwarded here.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 49
To this the chief surgeon rephed as follows, on January 12:
1 . The receipt is acknowledged of your letter of January 10th (4773-F) .
2. Personnel division. — -Every effort has been made since arriving in France to keep the
amount of work in the personnel division in this office down to the minimum. As the inspector
says, there is a card in this office for everj^ member of the Medical Department. It contains
only the minimum amount of information. I protest most emphatically against any proposi-
tion to remove this information from my office. It is utterU^ impossible for the chief surgeon
of the American Expeditionary Forces to administer his office without knowing the personnel
he has available. I am not at all concerned in regard to the automatic assignment of
personnel arriving in France except in such instances where it is absolutely necessary that it
shall be done from these headquarters. It wish to emphasize again that I would consider it
the greatest misfortune to bring details into my office which can be handled elsewhere: These
details have been given to the line of communications and to the different divisions wherever
it was possible to do so. This has been carried to such an extent that personal complaints
have actually been made from two of the divisions that they felt very materially the loss of
contact with the chief surgeon's office.
3. Hospitalization. — This paragraph hardly calls for remark except that I am not
prepared to state now that I agree with the statement of the inspector that the hospital divi-
sion should rest entirely in this office. This is a question that had been up many times since
these headquarters moved to Chaumont. It is being studied now and if improvement on
present conditions can be made it will be promptly reported to proper authorities.
4. Sanitation and statistics. — I am perfectly willing to remove from this office as much of
this division as is possible, having in mind particularly routine sick and wounded reports, with
the understanding that I be furnished with the information necessary to administer the office.
Attention is invited to the fact that the chief surgeon can not carry out his functions without
knowing the sick rate, the prevalence of epidemic diseases and the sanitary conditions of the
troops.
5. Record and correspondence. — It is hoped that the automatic replacement will relieve
this office of a great deal of the record and correspondence, and I will welcome any change in
this respect which will not decrease efficiency,
6. Mail. — The distribution of mail which is being done in this office was not of my choice;
it was forced upon the Medical Department. The condition which exists in this respect
to-day is almost intolerable and I will welcome any proposition which will take this matter out
of my office. It appears to me that this is a serious matter in the American Expeditionary
Forces. Attention is invited to the great dissatisfaction which will be continued throughout
the command if the delivery of mail, now so much delayed, is not accomplished with greater
expedition.
Until February 14, 1918, there had been no general medical inspectors in the
American Expeditionary Forces, but on that date two experienced officers were
assigned to this duty. Though these officers functioned in the division of
sanitation, chief surgeon's office, their reports considered the entire range of
Medical Department responsibilities.^*
On February 16, the date General Orders, No. 31, was pubhshed, reorganiz-
ing the American Expeditionary Forces, the chief surgeon's office included 19
officers, 55 clerks, and 4 orderlies. These were distributed as follows : Chief
surgeon; personnel section, 2 officers, 11 clerks; dental, 1 officer, 1 clerk; hospi-
talization, 5 officers, 5 clerks; supplies, 1 officer, 3 clerks; sanitation and statistics,
4 officers, 13 clerks; records and corespondence, 2 officers, 17 clerks, 4 orderlies;
veterinary, 2 officers; mail, 4 clerks; property, 1 officer, 1 clerk.
On February 22, the chief surgeon's office reported that in conformity with
the order mentioned above, 16 officers, 47 enlisted men, and 4 civilians, would
move to Tours.'^
50
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
By General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918, the
Medical Department was charged with the following duties : Sanitary inspection ;
health of command; care of sick and wounded; collection and evacuation of sick
and wounded; medical supplies; veterinary supplies; supply of personnel and
material for gas defense under supervision of director of gas service; technical
inspection of medical organizations and establishments.
In reply to a query from the general staff, A. E. F., concerning the personnel
that would be required by the chief surgeon's officers the tables of organization
for the Services of Supply, the chief surgeon, on March 8, 1918, submitted the
following estimate:
Tables of organization, chief surgeon's office, A. E. F., Services of Siipplij
Unit
Officers
Inter-
preters
Clerks
Sol-
diers '
Sol-
diers
Total
Remarks
General officer.
1
15
20
15
1
15
20
15
2
(a) Carried in headquarters battalion.
(b) 1 chauffeur, 1 orderly for general
OffiCGI".
(c) All from Medical Department, but
attached to headquarters battalion for
rations, pay, and clothing.
(d) Clerks.
(e) 3 chauffeurs, 5 clerks.
(/) 5 motorcyclists, 5 chauffeurs.
(g) Pistols for 9 chauffeurs, 5 motor-
cylists, 15 orderlies.
Colonels and lieutenant col-
onels.
Majors
Captains or lieutenants
Commissioned interpreters -
Total commissioned..
Field clerks
2
51
2
53
1- -
5
Master hospital sergeants
5
5
5
5
5
25
58
28
73
52
Sergeants major or battalion
•i 5
25
52
20
63
40
Sergeants
»4
1. 2
« 8
rio
12
Total enlisted
4
210
37
251
Aggregate
Closed cars..-
51
6
5
210
37
309
1
3
5
1
3
5
2
3
5
15
27
Touring cars __
Light cars
Motor cycles with side cars.
Motor cycles
2
3
I
'27
Bicycles
Horses, riding
10
Pistols
In compliance with General Orders, No. 31, G. H. Q., A. E. F., February
16, 1918, the chief surgeon's office arranged for removal of most of its personnel,
records, and property, on the night of March 20, to Tours, where it was installed
March 21.^^ Here it absorbed and superseded the office of the chief surgeon,
line of communications. On March 24, the office force of the chief surgeon,
A. E. F., included 33 officers and 2 nurses.
The organization prescribed by the chart approved by the commander in
chief on March 6, 1918, was in general that followed in subsequent develop-
ments.^'' The section charged with combat organization and new equipment
was taken over by the representatives whom the chief surgeon left with the gen-
eral staff at Chaumont, before he moved his office to Tours on March 21.*'*
The nomenclature of the records division was later changed to administrative
division, but its duties were unchanged.*^
52
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The chiefs of the 10 technical staff departments of headquarters, A. E. ¥.,
who were transferred by General Orders, No. 31, 1918, to Tours, were now
under the immediate jurisdiction of commanding general, Services of Supply,
in all matters pertaining to procurement, supply, transportation, and construc-
tion, but retained their titles and authority as members of the staff of the
commander in chief, A. E. F.*^ They were directed so to organize their offices
that the efficiency of their departments would not be impaired by absences for
conferences or other duties assigned them, and though their headquarters were
at Tours they were authorized and expected to travel throughout the American
Expeditionary Forces to investigate, direct, and supervise the work of all ele-
ments of their services, including those with combat units. The chief surgeon
thus occupied a dual status, for he was at once the chief surgeon of the American
Expeditionary Forces and of the Services of Supply.
In the Services of Supply the position of the chief surgeon in relation to
the general staff of that command, and with the heads of its administrative
staff departments, was altogether analogous to that which as chief surgeon, he
formerly had held with the corresponding departments of general headquarters,
A. E. F., at Chaumont.^^ In fact, as stated in the preceding chapter, the chiefs
of all administrative staff departments, A. E. F., except the adjutant general,
the judge advocate, and inspector general, A. E. F., had also been transferred
to Tours where they had the same dual status as had the chief surgeon.*^ With
the adjutant general, judge advocate, and inspector general of the Services of
Supply his relations were the same as with the chiefs of the other staff depart-
ments, but the scope of the Medical Department matters upon which they
took definitive action pertained to the Services of Supply only.*^ Though the
chief surgeon was represented on the general staff, A. E. F., at Chaumont, by
medical officers assigned to several of its sections, he was not represented on
the general staff of the Services of Supply at Tours except for a short period
when a medical officer was assigned to its first section.*^ Over his subordinates
in the several geographical sections (advance, intermediate, and base) into
which the Services of Supply was divided, the chief surgeon exercised super-
vision through the section surgeons who were members of the staffs of the
officers commanding those sections.^^ His office had direct control, except in
a few matters (especially discipline) over certain Medical Department forma-
tions which were removed from the jurisdiction of the commanding officer of
the section in which they were located; e. g. hospital centers, detached base
hospitals, medical supply depots, the central Medical Department laboratory,
Dijon, and such hospital trains as were assigned to his office.
The chief surgeon's office, after its location at Tours and its absorption of
the office of the surgeon, line of communications, was organized into the
following divisions (1) General administration, records and correspondence ;
(2) hospitalization, evacuation, and hospital administration; (3) sanitation,
sanitary inspection, and medical statistics; (4) personnel; (5) medical supplies';
(6) finance and accounting.
Under the chief surgeon and his executive officer, the commissioned per-
sonnel of the chief surgeon's office was distributed among its several divisions
on March 24, 1918, as follows Sanitation, 7; hospitalization, 6; personnel
4; supplies, 4; records and correspondence, 4; finance and accounts, 6.
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 53
A chief nurse and assistant chief nurse were at the head of the nursing
service in the personnel division, but members of the nursing staff were not
yet commissioned.
The assistant to the chief surgeon examined all papers going to the chief
surgeon for his signature and was authorized to sign these in his absence."
The finance and accounting section was composed of personnel recently arrived,
who had been selected from a unit that had been organized in the United
States to audit property and money accounts of the Medical Department in
France."
By June 3, 1918, the clerical force in the office of the chief surgeon had
grown materially, but was inadequate and on that date he recommended that
because of the great number of technical questions reaching his office and the
Fig. 3. -lleadnuartirs, Sirvicos of Supply, A. E. F., at Tours, viewed from within. The chief surgeon's office occupied
practically the entire first floor of the wing on the right
consequent necessity for trained noncommissioned officers, the enlisted per-
sonnel on duty therein should be authorized in the following proportions:*^
Master hospital sergeants, 2; hospital sergeants, 12; sergeants, first class, 35;
sergeants, 60; corporals, 26; privates, first class, 40; privates, 27; total, 202.
This number was exceeded by the latter part of July, 1918, for at that time
the personnel then on duty in the chief surgeon's office was 43 officers and 220
clerks.*^
A seventh section ,of the veterinary service, was organized in the chief
surgeon's office after the promulgation of General Orders, No. 139, on August
29, 1918.^" Before publication of that order, this activity had been under the
control of the remount service of the Quartermaster Department, its chief being
54
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
without administrative authority and having virtually the status of a technical
adviser only.'"' The general order mentioned, provided that the veterinary
service be transferred to the Medical Department and that a new section
charged with direction of veterinary affairs be created in the chief surgeon's
office of which the chief veterinarian was, therefore, placed in charge.^"
After its expansion by the addition of the veterinary division the chief
surgeon's office retained the general organization then provided though its
personnel steadily increased in number until after the armistice was signed.^"
On November 9, 1918, 58 officers were on duty in the chief surgeon's office,
distributed as follows: Chief surgeon, 1; assistant to chief surgeon, 1; general
administration, 1 ; detachment of enlisted men, Medical Department, 1 ; records,
1; library, 4; hospitalization, 13 (transportation, 7; sick and wounded, 5);
Fig. 4.— Building in Tours, in which the finance and accounting division of the chief surgeon's office was located
sanitation, 4 (sanitary inspection, 1); personnel, 4 (dental, 5; promotions, 1);
supplies, 5; finance and accounts, 4; veterinary, 6.
Other personnel who were in charge of specialties in the chief surgeon's
office but who were not commissioned included nurses and dietitians. It will
be noted that 25 of the 61 officers whose duties were classified above i. e.
more than 40 per cent — were serving in the hospitalization division.*^
The personnel serving in the chief surgeon's office or in immediate con-
nection therewith on November 11, the date the armistice was signed were
distributed by rank as follows Officers: Brigadier generals, 2; colonels (one
being the chief surgeon, later promoted), 6; lieutenant colonels,' 12 ; majors 6;
captains, 9; first lieutenants, 27; second heutenants, 6. Total, 68.
56
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Nursing service: Nurses, 2; enlisted men: Master hospital sergeants, 1;
hospital sergeants, 21; sergeants, first class, 55; sergeants, 83; corporals, 46;
cooks, 3; privates, first class, 26; privates, 43. Total, 278. Civilian em-
ployees, 76; grand total, 424.
PERSONNEL
(July 28, 1917, to July 15, 1919)
CHIEF SURGEON, A. E. F.
Brig. Gen. Alfred E. Bradley, M. C, to April 30, 1918.
Maj. Gen. Merritte W. Ireland, M. C, May 1 to October 9, 1918.
Brig. Gen. Walter D. McCaw, M. C, October 10, 1918, to July 15, 1919.
DEPUTY CHIEF SURGEON
Brig. Gen Jefferson R. Kean, M. C.
Brig. Gen. Francis A. Winter, M. C.
REFERENCES
(1) Letter from the Surgeon General, U. S. Arm\', to The Adjutant General of the Army,
May 10, 1917. Subject: Designation of Col. Alfred E. Bradley, M. C, as chief
surgeon. United States forces in Europe. On file, Record Room, S. G. O. (9795).
(2) Letter from The Adjutant General of the Army, to Col. Alfred E. Bradley, M. C,
American Embassy, London, May 28, 1917. Subject: Designation as chief surgeon
of the United States forces in Europe. On file, Record Room, S. G. O. (9795).
(3) Letter from the chief surgeon, A. E. F., to the Surgeon General, S. Army, June 11,
1917. Subject: Status. On file. Record Room, S. G. O. (9795).
(4) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F. (undated).
Subject: Outline report of chief surgeon, A. E. F., for use in preparation of the
report of the commander in chief. On file. Historical Division, S. G. O.
(5) Letter from The Adjutant General of the Army, to Col. A. E. Bradley, M. C, May
29, 1917. Subject: Assignment. On file, Record Room, S. G. O. 9785 (Old Files).
(6) Memorandum from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, American
Embassy, London, June 11, 1917. Subject: Administration of American medical
personnel serving with British Forces. On file. Record Room, S. G. O., 9795 (Old
Files).
(7) Final report of Gen. John J. Pershing, September 1, 1919, 5.
(8) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., June 21,
1917. Subject: Report of personnel of chief surgeon's ofl^ice. On file, A. G. O.,
World War Division, chief surgeon's files (321.6).
(9) Wadhams, Sanford H., Col., M. C, and Tuttle, Arnold D., Col., M. C: Some of the
Early Problems of the Medical Department, A. E. F. The Military Surgeon, Wash-
ington, D. C, 1919, xlv, No. 6, 636.
(10) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 14,
1917. Subject: Weekly war diary. Copy on file, Historical Division, S. G. O.
(11) Special Orders, No. 26, Headquarters, A. E. F., July 4, 1917, par. 2.
(12) Report from Col. Sanford H. Wadhams, M. C, the Representative of the chief surgeon,
A. E. F. with the General Staff G-4-"B" to the chief of the fourth section, general
staff, general headquarters, A. E. F., December 31, 1918. Subject: Activities of
the medical group, fourth section, general staff, A. E. F., for the period embracing
the beginning and end of America's participation in hostilities. Copy on file,
Historical Division, S. G. O.
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 57
(13) Final report from the adjutant general, A. E. F., to the commander in chief, A. E. F.,
from May 28, 1917, to April 30, 1919. On file, General Headquarters, A. E. F.
Records.
(14) General Orders, No. 42, G. H. Q., A. E. F., September 26, 1917.
(15) Memoranda from the chief surgeon, A. E. F., to the chief of staff, A. E. F., from July
14, 1917, to and including December 29. 1917. Subject: Weekly war diaries. On
file, Historical Division, S. G. O.
(16) General Orders, No. 20, G. H. Q., A. E. F., August 13, 1917; also memorandum from
the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 21, 1917. Subject:
Weekly war diary. On file, Historical Division, S. G. O.
(17) War diary, chief surgeon's office, A. E. F., July 21, 1917.
(18) Report of medical activities, line of communications, A. E. F., during the war period
(undated), by Brig. Gen. Francis A. Winter, M. C. On file. Historical Division,
S. G. O.
(19) Report on medical supply, A. E. F. (not dated), by Maj. A. P. Clark, M. C. On file,
Historical Division, S. G. O.
(20) War diary, chief surgeon's office, A. E. F., July 28, 1917.
(21) War diary, chief surgeon's office, A. E. F., August 4, 1917.
(22) War diary, chief surgeon's oflfice, A. E. F., September 2, 1917.
(23) General Orders, No. 8, G. H. Q., A. E. F., July 8, 1917.
(24) War diary, chief surgeon's office, A. E. F., August 26, 1917.
(25) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file, Historical Division, S. G. O.
(26) Memorandum from the adjutant general, A. E. F., to the chief surgeon, A. E. F.,
September 13, 1917. Subject: Project of Medical Department. On file, A. G. O.,
World War Division, chief surgeon's files (321.6).
(27) Memorandum from the chief surgeon, A. E. F., to the chief of staff, October 9, 1917.
Subject: Tables of organization. On file, A. G. O., World War Division, chief
surgeon's files (320.2).
(28) Memorandum from the chief surgeon, A. E. F., to the adjutant general, A. E. F.,
November 7, 1917. Subject: Chart showing subdivisions in his office. On file,
A. G. O., World War Division, chief surgeon's files (320.2).
(29) Personnel records. On file. Army Nurse Corps, S. G. O. (Bessie S. Bell).
(30) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April
17, 1917. Subject: Activities of the Medical Department, A. E. F., to November
11, 1918. On file. Historical Division, S. G. O.
(31) Tables of organization for general headquarters, A. E. F., in France, approved by
Gen. John J. Pershing, December 22, 1917. On file, A. G. O., World War Division,
chief surgeon's files (320.2).
(32) Letter from the adjutant general, A. E. F., to the chief surgeon, A. E. F., January 10,
1918. Subject: Report on investigation of methods of decentralization. On file,
A. G. O., World War Division, chief surgeon's files (321.6).
(33) Letter from the chief surgeon, A. E. F., to the adjutant general, A. E. F., January 12,
1918. Subject: Report of investigation of methods of decentralization. On file,
A. G. O., World War Division, chief surgeon's files (321.6).
(34) List of officers and clerks on duty in the chief surgeon's office, February 16, 1918. On
file, A. G. O., World War Division, chief surgeon's files (321.6).
(35) Memorandum from the chief surgeon, A. E. F., to the post quartermaster, February 22,
1918. Subject: Transfer to Tours. On file, A. G. O., World War Division, chief
surgeon's files (321.6).
(36) Memorandum from assistant chief of staff, G-3, A. E. F., to the chief surgeon, A. E. F.,
February 26, 1918. Subject: Tables of [organization for the service of the rear.
On file, A. G. O., World War Division, chief surgeon's files (320.2).
(37) Letter from the chief surgeon, A. E. F., to the commanding general, S. O. R., A. E. F.,
March 8, 1918. Subject: Tables of organization. On file, A. G. O., World War
Division, chief surgeon's files (320.2).
58 ADMINISTRATION, AMKKICAN EXPEDITIONARY FORCES
(38) War diary, chief surgeon's office, A. E. F., March 24, 1918.
(39) Scheme for organization of the medical department, submitted by the chief surgeon,
A. E. F., February 22, 1918, and approved by the commander in chief, A. E. F.,
:March 6, 1918. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(40) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., March 15,
1918. Subject: Organization. On file, A. G. O., World War Division, chief sur-
geon's files (320.2).
(41) Report on the administrative section of the chief surgeon's office, A. E. F., by Capt.
R. A. Dickson, M. A. C. On file. Historical Division, S. G. O.
(42) General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918.
(43) Report from Col. N. L. McDiarmid, M. C., to the Surgeon General, U. S. A., May 1,
1919. Subject: Activities of the supply division, chief surgeon's office, A. E. F.
On file, Historical Division, S. G. O.
(44) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., July 1,
1918. Subject: The Medical Department in the American Expeditionary Forces to
May 31, 1918. On file. Historical Division, S. G. O.
(45) First indorsement from the chief surgeon, A. E. F., to the assistant chief of staff, G-1,
A. E. F., June 3, 1918, on memorandum from assistant chief of staff, G-1, A. E. F.,
to chief surgeon, A. E. F., May 31, 1918. Subject: Table of organization. On
file, A. G. O., World War Division, chief surgeon's files (320.1).
(46) Memorandum from the chief surgeon, A. E. F., to assistant chief of staff, G-4, A. E. F.,
July 4, 1918. Subject: Office personnel and space. On file, A. G. O., World War
Division, chief surgeon's files (321.6).
(47) Circular No. 54, chief surgeon's office, A. E. F., November 9, 1918. On file, Historical
Division, S. G. O.
(48) Memorandum from the chief surgeon, A. E. F., to assistant chief of staff, G-1, A. E. F.,
December 2, 1918. Subject: Personnel and transportation. On file, A. G. O.,
World War Division, chief surgeon's files (321.6).
CHAPTER II
REPRESENTATION OF THE MEDICAL DEPARTMENT ON THE
GENERAL STAFF, A. E. F.
Before the organization of the American Expeditionary Forces little atten-
tion had been given to the subject of Medical Department representation on the
general staff, but as early as July, 1917, it became apparent that such repre-
sentation was essential for coordinated action.' A memorandum was formu-
lated on this subject at this time but no action resulted.' In February, 1918,
in conformity with a request of the commander in chief for frank discussion,
another memorandum was prepared, again inviting attention to the necessity
for Medical Department representation on the general staff and stating the
reasons for this.' But until February 16, 1918, when General Orders, No. 31,
general headquarters, A. E. F., was published, representatives of the chief
surgeon's office continued to take up with the section of the general staff con-
cerned, all Medical Department matters which required their coordination or
execution.'
When the American Expeditionary Forces were reorganized, as described
in Chapter I, the chiefs of the 10 technical staff services (including the Medical
Department) which were transferred from headquarters, A. E. F., at Chaumont,
to that of the Services of Supply at Tours, were authorized in their discretion
to designate officers of their respective services to represent them with each
general staff section at general headquarters.^ In conformity with this plan
the chief surgeon, on February 22, 1918, recommended that certain officers of
the Medical Department remain at general headquarters to represent him with
the several sections of the general staff.^ As his immediate representative he
designated a medical officer who was also the liaison officer with the central
bureau of the Franco-American section and with the French mission at general
headquarters. The office force left to assist this officer consisted of two officers
of the Sanitary Corps and eight clerks.^ The medical officers who were assigned
as assistants to the chief surgeon's representative were attached to the several
sections of the general staff as follows: One to G-1, 1 (who was also attending
surgeon at general headquarters) to G-2, 1 to both G-3 and G-5, and 2 to
G-4.^ The chief surgeon stated that when more medical officers were available
one would be attached to G-3 and another to G-5 instead of having one officer
attached to both these sections, but this plan was never realized.^ By May,
1918, representation with the second section of the general staff was found
to be unnecessary and was discontinued.*
There was also assigned to duty with the chief surgeon's representative
at Chaumont, an officer who was designated director of professional services.*
He was not attached to any section of the general staff, but was stationed
at Chaumont largely to lend him the facilities needed in administering his
important activities.*
60
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Technically the medical officers who were assigned to duty with the
several sections of the general staff at general headquarters were assistants to
the chiefs of those sections, but from another point of view they were, as
stated above, assistants to the chief surgeon's representative there.'
On March 15, 1918, the chief surgeon endeavored to have created a Medical
Department section of the general staff. His letter on the subject is as follows
Recently there has been a considerable readjustment in the organization of these head-
quarters. It is stated in General Orders, 31, c. s., that the organization there prescribed
had been arrived at after a careful study of both the French and British Armies. The
American Expeditionary Forces organization recently adopted resembles very closely the
French organization which has been in existence for some time.
It is pertinent to review briefly a few of the more important steps in the development
of the French organization since the beginning of the war especially in reference to its sani-
tary service. It was early found necessary to provide for Medical Department representation
in the Government, and this was done by creating the office of sous secretaire d'etat du service
de sante. Gradually it was learned by bitter expeiience that in order to insure coordination
of effort and the prevention of unnecessary sacrifice of life actual medical department par-
ticipation in the plans for combat activities was necessary; that is, representation on the
general staff. Consequently, several medical officers were assigned to the general staff of
the G. Q. G. and one to the general staff of each army.
While better coordination was secured the results were not entirely satisfactory. Since
the Champagne offensive of April, 1917, which was accompanied with a terrible death toll
and very great unnecessary suffering there has been a growing feeling that steps should be
taken to prevent the recurrence of a similar catastrophe. It was well recognized that a repe-
tition of this unfortunate occurrence might well have a profound and possible disastrous
effect on the morale of a people already exhausted and harassed by the unavoidable
hardships of a long war.
During the past three and one-half years many changes in organization have been found
necessary, changes which viewed in the light of pre-war days seem radical. All of these
changes have tended toward a more complete autonomy of the medical service, and it is
believed by the best thinkers in the French Army that a high degree of autonomy is essential
if the Medical Department is to successfully meet the conditions which modern warfare have
imposed upon it.
The latest change in the Medical Department organization in the French Army has very
recently been published under date of February 26, 1918 (see inclosures). This change is so
fundamental in character and so far-reaching in its consequence that I feel impelled to bring
it to your attention. By this change the Medical Department had been removed from the
close administrative control of the fourth bureau of the general staff. I am informed that
M. Clemenceau and General Petain have decided, in order that the medical service may
have everjr possible opportunity to accomplish the difficult task with which it is confronted,
to constitute a new section of the general staff of the G. Q. G. This section is designated
the service de sante, and has as its chief an experienced officer of the Medical Corps who
is an assistant chief of staff.
It seems particularly fitting at this time that inasmuch as our present organization is
modeled so closely on that of the French that we should not appear as having begun our mili-
tary effort with a medical organization which has been found wanting and has been discarded
by the French. Undoubtedly this step has been taken by the French after most mature
study, and with the experience of three and a half years of war as a guide. I feel it incumbent
upon me to urge careful consideration of this matter and to recommend that a similar organiza-
tion be adopted for the A. E. F. If this recommendation is approved, as I feel it must be
sooner or later, it is my intention to request the detail of one of the several experienced
senior officers of the Medical Corps now in France as chief of this section. I am convinced
that while the recently prescribed organization is a vast improvement over that which has
been in effect, the gain in saving of life and the prevention of unnecessary suffering which
may reasonaVjly be expected from adopting the proposed change will be immeasurably
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 61
greater. The present organization in the American Expeditionary Forces places a line officer
of the general staff in position to pass upon or present for higher consideration all matters of
fundamental policy affecting the Medical Department. He can nullify the most carefully
worked out program having for its object Medical Department efficiency. I am convinced
that proper coordination of the medical service with the troops in the zone of the armies can
be secured in no other way than that outlined above.
This matter was referred to the chief of the fourth section, general staff,
who reported upon it adversely;^ however, the chief surgeon, on April 30,
renewed his recommendation in the following letter:^
On the 15th of March, 1918, a letter was sent you from this office calling attention to the
fact that the Medical Department was handicapped in its extensive and complex operations
by being cut off from direct access to the chief of staff and having to operate through two
divisions of the general staff, and suggesting that a remed\' be found in the creation of a
medical section of the general staff.
In the six weeks which have elapsed since that letter was forwarded, the transfer of the
chief surgeon's office to the Services of Supply has been tested in actual operation, and has in
many ways greatly facilitated the transaction of business, especially in matters concerning
supplies, the distribution and training of personnel, and the construction of the hospital
accommodations for the great Army which is being transferred from the camps of mobilization
at home to France.
It Vjecomes daily more apparent, however, that it has resulted in a disconnection of the
chief surgeon's office from the medical administration of the front to an extent which makes
it practically impossible for the chief surgeon to meet his responsibility for the conduct of
medical affairs in the zone of the army.
It is requested, therefore, that a reply be made to this letter, stating the action taken with
regard to it and, if unfavorable, the reasons which rendered favorable action inexpedient.
It is hoped that by a study of these reasons a solution may be arrived at which may be accept-
able to the commander in chief and may relieve the very serious administrative difficulties
which now exist.
As the chief surgeon was never informed officially of the objections, he was
not in a position to discuss them. This matter lapsed and no Medical Depart-
ment section of the general staff, comparable to that of the French Army was,
created at this time or later. ^
None of the medical officers attached to the general staff became members
of that body until some time later. By General Orders, No. 73, G. H. Q.
A. E. F., May 10, 1918, two of them were detailed acting general staff officers,
and by General Orders, No. 138, G. H. Q., A. E. F., August 23, 1918, the same
official status was given two others.
The representative of the chief surgeon, at general headquarters, established
his office with that of the two medical officers assigned to the fourth section of
the general staff This section as described in Chapter I, was concerned with
supply and transportation in the American Expeditionary Forces, initial troop
movements, hospitalization, evacuation, utilities, and labor. ^ It formulated
policies in these matters; the Services of Supply or other agency executed them.^
The assistant chief of staff, G-4, organized in his office a subsection, the medical
section, designated "G-4-B." which was charged with Medical Department
affairs, and it was with the group composing this section that the chief surgeon's
representative identified himself.^
Composition of the medical section, G-4, varied according to circumstances,
but on the average included four medical officers of field rank, two officers of
the Sanitary Corps for office management, and a small clerical force. ^
62
ADMINISTRATION, AMERICAN KXI'EDITIONARV FORCES
On May 2, 1918, the Medical Departmont officers on duty at head-
quarters consisted of the representative of the chief surgeon and one assistant,
one officer attached to G-1, one attached to G-3 and to G-5, two attached to
G-4, an assistant to these last mentioned, who was in charge of records, a
director of professional services and his assistant.*
With the separation of the chief surgeon's office from general headquarters,
A. E. F., the chief surgeon's relations with the combat forces virtually ceased,
but no agency was formally provided for the control, direction, or supervision
of Medical Department activities in the zone of the armies.' Therefore, his
representative at general headquarters supervised all activities of the Medical
Department during combat.' Demands upon the medical section, G-4, con-
stantly grew, for it soon became the center to which were referred all matters
affecting the Medical Department, whether they arose at headquarters, A. E. F.,
or were referred to it from other sources for recommendation or suitable
action.' Except in matters pertaining to priority shipments of supplies and
personnel from the United States, training, equipment, and operations, this
fourth section controlled most of the policies of the Medical Department, not
only in the Services of Supply, but throughout the American Expeditionary
Forces, including the zone of the armies.' It was for this reason that the repre-
sentative of the chief surgeon had identified himself intimately with this
section.' Gradually nearly all the Medical Department activities at general
headquarters were coordinated under the medical section, G-4, and no impor-
tant questions of policy were decided until they had been examined by this
group.' The medical officer assigned to G-1 actually served as a member of
this group, but was placed with G-1 to handle certain specific problems per-
taining to ocean tonnage which were under control of that section.' All
actions initiated in the group were of course executed over the signature of
the assistant chief of staff, G-4. This system was followed, even with questions
involving another section.' In this case a memorandum was usually prepared
for the other section of the general staff involved, and transmitted to it through
the assistant chief of staff, G-4.'
Orders affecting Medical Department activities in the Services of Supply
were promulgated from that headquarters at the direct instance of the chief
surgeon, A. E. F., while those affecting service of the Medical Department in
the American Expeditionary Forces as a whole, as well as in the zone of the
armies, were issued, on request of the chief surgeon's representative, from
general headquarters at Chaumont.^
Before they made recommendations concerning the establishment of
pohcies or took action upon them, the representatives of the chief surgeon
mvariably submitted them to him for approval.* Daily at 8 a. m., andoftener
in emergencies, the chief surgeon and his deputy discussed by long-distance
telephone the problems demanding solution.* Mail sent by courier from one
office to the other reached its destination in 12 hours. By these means and
by semimonthly visits to Chaumont for the purpose of attending conferences,
the chief surgeon kept constantly in touch with the activities and interests
of the Medical Department at general headquarters, and was able to supervise
Medical Department activities in the zone of the armies and in the American
Expeditionary Forces as a whole.*
ORGANIZATION AXJ) ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 63
The medical officers assigned to duty with G-4 previously had been iden-
tified with the hospitalization division of the chief surgeon's office, and in that
capacity had dealt with G-4 directly in matters pertaining to hospital procure-
ment.' As a part of such procurement they had sought to make provision for
field and evacuation hospitals as well as for the base hospitals in the Services of
Supply.' Also they had supervised and directed evacuation of patients from
divisions in training areas and in quiet sectors. Therefore, it developed that
the medical section, G-4, handled all questions relating to hospitalization,
evacuation, ■ and other interests of the Medical Department throughout the
American Expeditionary Forces which required the attention of general head-
quarters.' One very important detail of its service was the prosecution of
construction and procurement program, in its relation to hospitalization and
depot policies of the chief surgeon's office.' Another was support of Medical
Department interests when in certain projects these conflicted with those of
another branch of the service.' After American troops began to participate
in active operations the duties of this group underwent a tremendous increase
in scope for it was then charged with general control of Medical Department
activities in the field.' Questions continued to arise in connection with the
hospitalization and evacuation policies of the Services of Supply, but aside
from these the group now became occupied chiefly with matters pertaining to
field operations and combat activities.'
When the medical section, G-4, was organized it had not been anticipated
that control of field operations of the Medical Department would devolve upon
it, but no other agency was provided and such devolution was in fact a logical
development for the reasons noted above.** The deputy of the chief surgeon
at general headquarters, and the other members of the group attached to G-4,
constituted the only connecting link between the chief surgeon, A. E. F. and
the medical service of armies, corps, and divisions.^
From the beginning of our military operations the medical section, G-4,
was called upon to meet the daily emergencies of battle situations as they arose,
and to cooperate in developing and applying the general policies of the entire
Medical Department of the rapidly growing American Expeditionary Forces.^
During the more important operations two officers of the group were almost
constantly at the front where they represented G-4 in the coordination of hos-
pitalization, evacuation, and medical supply.^ Before corps and armies of
the American Expeditionary Forces were organized they performed, in addition
to their other duties, duties comparable to those of a corps or army surgeon,
for at that time there was no other agency through which the higher coordi-
native functions of the Medical Department could be exercised during combat.
For example, representatives of the medical section, G-4, supervised and
directed hospitalization and evacuation of the 1st Division at Cantigny; of
the divisions and corps constituting the Paris group in the Marne area; and of
the 42d Division in the Champagne sector.^ Before a chief surgeon for the
First Army was designated in July, 1918, members of G-4-B, therefore, dis-
charged such duties as then devolved upon that office.^ They also effected
evacuation from corps and divisions serving under control of the French or
British and provided for their supply of Medical Department materiel.^
13901—27 5
64
ADMINISTRATION, AMERICAN EXPEDITIONARY' FORCES
So far as their jurisdiction extended the chief surgeons of the First, Second,
and Third Armies relieved the deputy of the chief surgeon at G-4 of the duties
pertaining to hospitalization, evacuation, and medical supply which the latter
previously had discharged for corps and divisions at the front.
The hospitalization and evacuation plans for the St. Mihiel and Meuse-
Argonne operations, in so far as procurement and evacuation were concerned,
were largely prepared in G-4-B and placed into effective operation through
personal consultation with the chief surgeons of the First and later the Second
Armies.' Careful estimates of prospective battle casualties were formulated
and every available resource drawn upon to care for them. Owing to limited
resources, it frequently became necessary to move sanitary formations and
resources from one army to another, or to the service of detached divisions.'
The difficulties of contact, between the general staff and the Medical
Department engaged in the service of the front, which had occurred during
the battles in the Marne area, were greatly ameliorated when medical officers
were detailed to the various sections of the general staff at general headquarters,
and when a newly appointed assistant chief of staff took over the duties of G-4.*
This officer now uniformly acquainted members of the medical section G-4 with
plans, situations, and policies so that they were able to make preliminary arrange-
ments to the best advantage and to promote intelligently the efforts of the
chief surgeons of the various armies, corps, and divisions concerned.^ As the
group kept in close contact with those officers, and learned their facilities and
needs for future requirements it was thus in a position to render them prompt
assistance when required.*
The machinery for coordination of effort, consolidation of resources, and
elasticity of control of limited resources, as reffected in the authority of the
assistant chief of staff, G-4, permitted the maximum utilization of facilities.*
Without the interest which was manifested by the assistant chief of staff, G-4,
in the activities of this subsection and his practice of notifying it of impending
battles, or movements of troops, it would have been impossible for G-4-B to
have met emergencies which continually arose.*
The geographical location of general headquarters permitted the mainte-
nance of close contact between members of G-4-B and the surgeons of divisions,
corps, and armies.* It was possible for a member of this group not only to
reach rapidly almost any part of the front occupied by American troops, but
also through an excellent system of telephone and telegraph communication to
know at all times exactly the conditions to be met.* Largely because of this
fact the representatives of the chief surgeon with G-4 were able to meet the
daily problems which arose from the lack of authorized personnel, sanitary units
and equipment with the troops; such problems they met by moving from one
sector to another, on orders which G-4 initiated, casual personnel, operating
teams, and sanitary units, ambulance companies, field, evacuation, and mobile
hospitals.* Limitations of personnel were such that without this machinery for
coordination of effort and consolidation of resources, evacuation, and hospitafiza-
tion of battle casualties would have been well nigh impossible.* The activities
of this group which pertained to supervision of medical service at the front are
further discussed in Volume VIII of this history.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 65
G-4-B was also closely in touch with the American Red Cross, especially
in projects concerning hospitalization, and convalescent homes.* The relations
of that society to G-4-B were so intimate and so important that an attempt was
made to have it transferred from the jurisdiction of G-1 (which had control of
all such societies operating in the service of the American Expeditionary Forces),
to that of G-4, in order to expedite transaction of business between the two of-
fices, but this was unsuccessful.^ The representative of the Medical Depart-
ment with G-1 coordinated the activities of the American Red Cross with the
policies of the Medical Department, in so far as they pertained to that depart-
ment, the hospitalization enterprise of the American Red Cross being under-
taken in conformity with requests of the medical group with G-4.*
On September 20, 1918, the chief surgeon's deputy, general headquarters,
submitted the following memorandum to the acting chief of staff, G^, concern-
ing the organization of the medical section, G-4 : ^
The following table exhibits the personnel that I believe will be necessary to carry on the
functions now devolving upon this subsection of your office. It contemplates no radical de-
parture from the organization which has been in effect.
Brigadier general, 1; colonels, 2; lieutenant colonels, 2; majors, 2; captains or first
lieutenants, 4; total commissioned, 11. Civilian clerk, 1; master hospital sergeant, 1; hospital
sergeants, 2; sergeants, 1st class, 3; sergeants, 3; corporals, 2; privates, 1st class, 4; pri-
vates, 1; total enlisted, 16.
The table proposed off hand may appear to be top heavy. As a matter of fact the
personnel estimated will barely be sufficient to carry on the work which is now coming to this
subsection. As G-4 handles practically all the medical matters coming to general head-
quarters; it is believed that all technical matters affecting the Medical Department should
be referred to this subsection. While General Orders 31, contemplated that we should have
a representative in each section of the General Staff, it is believed that better results will
accrue if we concentrate all the authorized personnel in this section excepting the officer
assigned to G-5 for training purposes. Until recently we had attached to G-1 a medical
officer who was assigned to the General Staff. Instead of replacing him in that section it is
believed that the work carried on by him there should be performed by an officer in this sub-
section of G-4.
Until the organization of the First Army headquarters, this office was in fact the office
of the chief surgeon of the army. At the present time it is carrying some of the duties of that
army, and all of such duties in connection with certain other more or less detached combat
units. The chief surgeon's office is, from the point of view of distance, remote from the front,
and its contact with combat units is correspondingly slight. The necessity of providing the
details of organization, instruction, mobilization of new equipment and personnel for combat
units, the initiation of movement orders, etc., must all originate from this section. As a matter
of fact the duties which have devolved upon and are now being performed by this subsection
have been much broader in scope than it was believed by the chief surgeon was contemplated
in the plan of organization at the time General Orders 31 was adopted.
Every effort has been made to decentralize, as far as possible, all details concerning the
Medical Department and to devote the time of officers on duty here to constructive work,
which is gradually assuming greater and more pressing proportions. Up to the present,
with the number of officers now available this has practically been impossible, as the entire
time of officers now connected with the subsection have been taken up with routine daily
matters. It is daily becoming more evident that the chief surgeon's office, per se, has become
what might properly be called a surgeon's general's office in France, and is occupied with the
provision of materiel and personnel necessary to secure proper functioning of the Medical
Department of the American Expeditionary Forces. There is another and most important
side to the Medical Department's activities, and this is the relation of the department to
combat operations. From a Medical Department viewpoint, supply is a comparatively
66
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
minor consideration. The care of the sick and wounded and the evacuation and h(jsi)itali-
zation of these cases is always more or less an emergency measure and recj wires very com-
plicated machinery to secure the desired results. The present organization, as prescribed by
General Orders 31, does not provide the elasticity or necessary facilities for this most impor-
tant part of the Medical Department duties. It is understood that General Orders 31 is
now being rewritten with a view of correcting its organizational defects and incorporating
features which have been the outgrowth of our experience under its operation.
The necessity of having a deputy of the chief surgeon at these headquarters has become
generally recognized. Under our present scheme of organization it is necessary that the
chief surgeon should have at these headquarters an officer who truly represents him and
whose duties are more particularly those which pertain to Medical Department functions
with and relations to combat troops. To produce satisfactory results requires a considerable
organization. In every action of magnitude representatives from these headquarters must
leave for the front for the purpose of coordinating hospitalization and evacuation until
activities again assume a normal trend. It seems only logical that, inasmuch as all Medical
Department activities are coordinated by G-4 of the general staff, its senior medical officer
with that section of the general staff should be the chief surgeon's deputy. That is the
situation which has gradually evolved since the chiefs of the services were divorced from
these headquarters. As stated above, the desirabihty of not only continuing this organiza-
tion, but recognizing the responsibilities and duties of the senior medical member of G-4
seems apparent. Because of the nature of the work and responsibilities devolving upon the
chief surgeon's deputy, it is believed that the officer who occupies that position should have
the rank of a general officer. On a recent visit to these headquarters the chief surgeon an-
nounced that it was his intention to recommend that his deputy here be a brigadier general.
For that reason one brigadier general is shown on the above table. If the functions to be
carried out b^* this subsection of your office are to be successfully accomplished the personnel
indicated will be absolutely essential. The enlisted personnel given function largely in the
same capacity as do field clerks in other subsections.
On August 14, 1918, the commander in chief, upon being advised by the
chief of staff that the Medical Corps had asked for fuller representation on the
general staff, stated he desired this request to be complied with.^" Accordingly,
a medical officer who had been on duty with G-1 was made an acting general
staff officer," and all divisions of the general staff were advised that he should
be consulted on:
(a) All affairs of the Red Cross that have any possible connection with the Medical
Department; (6) all Tables of Organization of medical units or which should show medical
personnel attached; (c) changes in the type of equipment or clothing or ration, so far as they
may affect health, or where, in the case of equipments, it is for the Medical Corps; (d) miscel-
laneous questions affecting the Medical Department.
The representative of the Medical Department with G-3 was concerned
chiefly with movement of medical units ; e. g. , evacuation hospitals. It appeared
advisable that the Medical Department should be represented on G-3 in order
that its plans might be coordinated with combat operations in general.^ This
representative of the chief surgeon also served with G-5, and, in that assign-
ment, was in charge of the training of Medical Department personnel whether
they were members of units in the Joinville training area, of units or detach-
ments with divisions, or in attendance at the Sanitary School at Langres.'
In his final report the deputy of the chief surgeon at General Headquarters
wrote concerning Medical Department representation on the general staff
with especial reference to that with its fourth section as follows: ^
ORGANIZATION AND ADMIN'ISTBATION OF CHIEF SURGEON'S OFFICE 67
Tlie jiresent method of providing for Medical Department representation on and with
the general staff is ideal, and is favored over all other previous propositions. Medical
Department representation on the general staff as conceived by the acting chief of staff,
G-4, more nearh" approaches the ideal of organization than any other plan which has been
proposed. It is hoped that the policy inaugurated by the chief of the fourth section in this
respect will have demonstrated its value, and will be perpetuated in any future reorganiza-
tion of the general staff. It is also hoped that the results obtained by this section of the
general staff have amply demonstrated the wisdom of having adequate Medical Department
representation on the general staff.
Under this organization (General Orders, No. 31) the chief surgeon's office became
merely an agency for the procurement and distribution of supplies and personnel and wa^
completely separated from the Medical Department activities connected with the Zone of
.\ctive Operations.
The classification of the Medical Department among the supph' services is question-
able. Its functions are so intimately connected with combat activities that it becomes a
very difficult matter to administer this branch of the service if it is placed on the same basis
as the purely supply departments.
In providing the necessary medical supplies for an army only one of the comparatively
unimportant functions of the Medical Department has been fulfilled. The demands made
upon the Medical Department by combat activities can not be satisfied if the prevailing
conception of that department as a supply department is adhered to.
The organization of headquarters, general headquarters, A. E. F., as first outlined in
General Orders, No. 8, 1917, followed very closely that in operation in the French Army at
the time, except that for the latter army generous provision was made in the way of Medical
Department representation on the fourth bureau of the general staff and none was provided
for ours. As stated above, this defect was corrected some months later, after representation
had again been made by the chief surgeon.
In the meantime a reorganization of the French general staff went into effect in March,
1918. This change created an additional or fifth bureau of the general staff, which was made
up entirely of medical officers and was known as the Medical Department bureau. The
senior officer of the section was a major general, with the title of assistant chief of staff, with
the same responsibilities and privileges as his brother officers of the line of other bureaus of
the general staff.
A short time before the French had published this change in staff organization, a memo-
randum for the commander in chief had been prepared in the office of the chief surgeon
recommending this identical organization. This recommendation was never approved or
disapproved, and the lack of action in the matter was a source of bitter disappointment to
tlie chief surgeon.
In so far as general representation on the general staff is concerned, not only
at headquarters, A. E. F., but also at headquarters, Services of Supply, the chief
surgeon expressed his opinion on March 24, 1919, as follows
It is not believed at this time that a separate or medical section of the general staff
should be created, but the medical services of the American Expeditionary Forces should be
placed under G-4, general headquarters. The chief surgeon should be represented by a
fleputy on G-4, of high rank. In his relations with the general staff, general headquarters,
he should be represented by one or more assistants on G-1, G-3, and G-5, as well as the
necessary additional medical officers on G-4. It is not believed that there is any necessity
for representation on G-2, general headquarters.
The chief surgeon has no executive jurisdiction over his own corps in the armies except
through the executive branches of the general staff, general headquarters. He also is so
dependent upon the other supply departments for operating hospitals, supplies, and evacua-
tion as to make it impossible for him to function without the executive assistance of the
general staff. Services of Supply.
Therefore, in order to make the machinery move rapidly and smoothly, it is absolutely
necessary to have general staff representation in both general headquarters and Services of
68
ADMIXISTRATION, AMERICAN EXPEDITIONARY FORCES
Supply so as to insure the rapid and coordinate dissemination of information of daily changes
at the front and to meet all demands intelligently and rapidly with the proper cfiuipnient,
personnel, etc.
Under the present arrangement, in which the deputy chief surgeon is attached to G-4,
general headquarters, the operation has functioned in an admirable manner, but this is
recognized as being due in a large measure to the admirable cooperation given to the deputy
chief surgeon on G-4 by the assistant chief of staff, G-4.
In this connection, attention is called to the fact that there was no medical representative
on G-3, the G-4 group performing the functions that should have been delegated to the G-3
representatives. It is believed that representation on G-3 is necessary.
In connection with the headquarters, Services of Supply, the chief surgeon should have
had an office with a deputy in charge to operate the Services of Supply activities of supply,
hospitalization, statistics, finance and accounting. Services of Supply personnel, dental service,
and veterinary service.
The office of the chief surgeon should be represented by assistants on G-1 and G-4 of
the general staff. Services of Supply, this in view of the fact that the hospitalization division
is intricately connected with and dependent upon every other supply department, and in
order to maintain the proper service, should be represented on G-1 and G-4 of the general
staff with such executive power as to be able to secure hospital construction or procurement
by lease or rent, as well as transportation of supplies, personnel, and sick and wounded.
THE CHIEF SURGEON IN CONNECTION WITH THE ARMIES
It is well understood that orders of execution can only be given to the army through the
different sections of the general staff at general headquarters, but in view of the chief sur-
geon's responsibility for the sanitary personnel, equipment, professional services, hygiene,
etc., of the armies, he should be in close touch with the surgeons of the armies, army corps,
and divisions. The chief surgeon of an army should have a medical representative on each
G-1 and G-4 of the army.
The following table is submitted:
Location.
Operations — G. H. Q.
Chief surgeon.
Personnel (for army areas only).
Army equipment, medical, from advance medical supply depots.
Evacuation of sick and wounded.
Hospital trains.
Ambulance and motor transport.
Operations of same.
Supplies — S. O. S.
Deputy chief surgeon.
Hospitalization.
Supply department.
Statistics — sick and w^ounded.
Personnel (S. O. S.).
Hospital trains, ambulances, and motor transport.
Supply and equipment of same.
Finance and accounting.
Dental service.
Veterinary service.
Professional services.
Ge;ieral sanitation — inspecting, epidemiology, laboratories.
Relations with the general staff.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 69
The chief surgeon's representation on the general staff should be as follows:
G. H. Q.:
G-1. An assistant in connection with supply problems, railway and automatic
overseas tonnage.
G-3. An assistant to coordinate the chief surgeon's office with combat operations in
general, and change of stations of army units.
G-4. A deputy chief surgeon and necessary assistants in connection with the
evacuation of sick and wounded, hospitalization, all construction and pro-
curement of buildings, assignment of units.
G-5. An assistant in connection with Medical Department training.
S. O. S.:
G-4. One or more assistants in connection with hospitalization and evacuation of
sick and wounded.
G-1. One assistant in connection with all tonnage and problems.
Army headquarters :
G-1. An assistant to the chief surgeon of the army.
G-2. An assistant to the chief surgeon of the army.
Corps and division headquarters: No representation of general staff
deemed necessary.
REFERENCES
(1) Report from Col. S. H. Wadhams, M. C, the chief of the medical group, fourth section,
general staff, general headquarters, A. E. F., to the chief of G-4, general staff, general
headquarters, A. E. F., December 31, 1918. Subject: Activities of G-4 "B," 4.
(2) General Orders, No. 31, General Headquarters, A. E. F., February 16, 1918.
(3) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., February
22, 1918. Subject: Designation of medical officers to represent chief surgeon at
general headquarters. On file, A. G. O., World War Division, chief surgeon's
files (321.6).
(4) Memorandum from the representative of the chief surgeon, A. E. F., with general
headquarters, A. E. F., medical section, general staff, to the chief of staff", A. E. F.,
May 2, 1918. Subject: Duties of officers of Medical Department at general head-
quarters, A. E. F., G-4-B. On file, A. G. O., World War Division, chief surgeon's
files (321.6).
(5 Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., March 15,
1918. Subject: Organization. On file, A. G. O., World War Division, chief surgeon's
files (321.6).
(6) Memorandum from acting assistant chief of staff, G-4, to the chief of staff, April 6,
1918. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(7) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., April 30,
1918. Subject: Need for medical section, general staff. On file, A. G. O., World
War Division, chief surgeon's files (321.6).
(8) Wadhams, S. H., Col., M. C, and Tuttle, A. D., Col., M. C. : Some of the early problems
of the Medical Department, The Military Surgeon, Washington, D. C, 1919, xlv.
No. 6, 636.
(9) Memorandum from the medical representative of the chief surgeon, general headquarters,
A. E. F., fourth section, general staff, to the acting chief of staff", G-4, September 20,
1918. Subject: Plan of organization for the medical or "B" division of G-4. On
file, A. G. O., World War Division, chief surgeon's files (321.6).
(10) Report from the commander in chief, A. E. F., to The Adjustant General of the Army
(undated), part 8, Vol. I, "Activities of G-1," 29. On file. General Headquarters,
A. E. F. Records.
(11) General Orders, No. 138, General Headquarters, A. E. F., August 23, 1918.
(12) Letter from the chief surgeon, A. E. F., to the chief of staff, A. E. F., March 24, 1919.
Subject: Relation of chief surgeon's office to S. O. S., G. H. Q., and the armies. On
file, A. G. O., World War Division, chief surgeon's files (321.6).
CHAPTER in
LIAISON OF THE MEDICAL DEPARTMENT, UNITED STATES ARMY,
WITH THE MEDICAL SERVICES OF THE ALLIES
LIAISON WITH THE BRITISH MEDICAL SERVICE
On June 9, 1917, the chief of staff, A. E. F., notified one of our medical
officers, who had been serving as military observer, of his assignment as liaison
officer with the Director General, British Medical Service, in connection with
the administration of American medical units serving wdth the British.' The
necessity for such an assignment is indicated by the chief surgeon, A. E. F.,
who, on June 11, 1917, w^rote the Surgeon General in part as follows, concerning
his relationships with the above-mentioned units and with casual American
personnel assigned to the British forces:^
As already reported to your office, I assumed some weeks ago an unauthorized super-
visory control over American medical personnel arriving in England, for service with British
forces.
My position was such I could neither act nor advise in any authoritative manner and
my relations with the personnel and the British medical officials has been purely advisory.
Many points had arisen which required decisive action or opinion, and I laid the whole
matter before General Pershing with my recommendations and suggestions. These he
approved and a memorandum has been issued as the result * * *
It is General Pershing's understanding that this medical personnel with the British is
not at this time under his control. If this understanding is erroneous, information is re-
quested by cable, for I will sever my connection with this personnel, and the British medical
service on my departure for France, and as chief surgeon, A. E. F., will exercise no super-
vision unless it is explicith- directed by the War Department. * * *
Before headquarters moved to Paris the chief surgeon wrote the liaison
officer with the British as follows:^
Inclosed herewith is a copy of a memorandum prepai'ed this date. Copies have been
supplied to the following officers:
Commanding officer, United States Army, Base Hospitals Nos. 2, 4, 5, 10, 12, 21.
Director general, British medical service.
Surgeon General, United States Army, Washington, D. C.
Liaison officer, Adastral House, Victoria Embankment.
*******
Adjutant general, American Expeditionary Forces.
The Adjutant General, United States Army, Washington, D. C.
Judge advocate, American Expeditionary Forces.
Quartermaster, American Expeditionary Forces.
This memorandum covers in a general way the results of all that has been done in con-
nection with this personnel.
In so far as the British War Office is concerned it is the result of conferences with the
director general and his asststant, General Babtie, and it has the approval of the commanding
general.
There has been no word of instruction of any kind received at this embassy from Wash-
ington regarding this personnel. They have been ordered to report to Lieut. Col. A. E.
Bradley, M. C, for instructions and have all been reported by him to the War Office for duty.
71
72
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Lacking instructions and information, no office has been organized nor established for
administrative purposes. The matter was placed before General Pershing on his arrival
and recommendations made which are embodied in the accompanying memorandum.
It is suggested that you look to the base hospitals for such office enlisted personnel as
may be needed for the administration of the American necessities. No doubt some British
assistance will be forthcoming on your proper representation of the necessity therefor.
Fifty-two medical officers, unattached to organized units, have reported up to date.
Many of these have gone to France and some have been assigned here in England. Others
are awaiting assignments. * * *
The Surgeon General has written me a personal letter that besides the six base hospitals
already here, he proposes to send, in June, 200 medical officers and 200 nurses, and similar
numbers in July and August.
The commanding officer of Base Hospital No. 2 has made inquiries as to promotion of
men of his enlisted force, and steps should be taken promptly to obtain the necessary authority
from the Surgeon General to promote privates, and to conduct examinations for the making
of noncommissioned officers.
Personal reports have been forwarded, but some personnel returns, etc., have been held
until some check could me made by an authorized central office which is established by this
action of the commanding general. These held papers and some little correspondence have
been left for you in the embassy office.
* * *****
After the chief surgeon had received from The Adjutant General, United
States Army, the letter quoted in Chapter II, which prescribed the scope of his
authority,^ he wrote our liaison officer in London on June 25, as follows: ^
Inclosed herewith is a copy of order making the assignment of "Chief surgeon. United
States forces in Europe," which has been received since the preparation of memorandum
and letter of instruction to you dated June 11, 1917.
It will be noted that authority in all matters in Europe pertaining to the Medical
Department is vested in the chief surgeon, A. E. F., and you will be guided accordingly.
The instructions contained in the letter referred to above are therefore modified as
follows:
(a) You will in future, in general, in your relations with this office and the American
medical units and personnel with the British medical service, act as w-ould a surgeon of a
department in the United States.
(6) All reports, requisitions, returns, etc., of whatever nature will be forwarded to this
office. The number of copies in each case will be that fixed by regulations governing under
war conditions.
(c) It is directed that for all commissioned personnel and all unattached enlisted and
civilian personnel, you make, in your office, nominal monthly check lists showdng the address
and duty of each individual. After making these lists you may transmit direct to the
Surgeon General the personal reports received by you instead of forwarding them to this
office, sending only to the chief surgeon the check lists above referred to.
(d) It is desired that all United States Army hospital units make reports each month,
through United States medical channels, of the work being done by them — a numerical
report of all cases treated by the organization in the hospital served by them.
All instructions contained in the memorandum and letter of June 11 conflicting with
these instructions of this date are revoked.
The liaison officer with the British medical service, with office in Adastral
House, kept the records, reports, and pay accounts, and cared for the mail of
all American officers, nurses, and enlisted men of the American Expeditionary
Forces on duty with the British.*' He was later assisted by two commissioned
officers and four clerks. In discharging these duties he kept trace of the assign-
ment of those members of our medical department who were assigned to duty
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 73
with the British, assisted them in obtaining pay and allowances, procuring
leaves of absence or sick leave, and promoted their interests in other matters.^
For example, when any were taken prisoner, he reported that fact to the Ameri-
can Red Cross, which undertook to send them packages of food and to com-
municate with them and their families in the United States.^ He also reported
to the chief surgeon, A. E. F., those officers under his jurisdiction who were
recommended for promotion and assembled the records on which these recom-
mendations were based. This was an important subject in which the personnel
concerned so interested themselves that there was almost constant agitation in
connection with it. For this reason this subject engaged a large proportion of
the efforts of the liaison officer and of those of his office force.^ Another of his
duties was to arrange when necessary for the transfer, to the direct control by
the headquarters, A. E. F., of those members of the Medical Department under
his supervision, who required discipline.'^ He investigated such cases, procured
witnesses, and reported them to the chief surgeon, American Expeditionary
Forces.*^
Through the liaison officer for the Medical Department in London, the
medical officers serving with the base hospitals assigned to the British were in
much closer contact with the chief surgeon's office than were the casual American
medical officers assigned to British units. As mentioned in the chapter on
*' Personnel," there was great difficulty at first in reaching these casual officers,
and because of their ignorance of regulations, general orders, etc., they seldom
reported changes of status. In many cases officers served with the British for
months before they became of record in the chief surgeon's office, A. E. F.
The liaison officer procured the records, statement of cause of disability,
whether in line of duty or not, and other data required for our sick and wounded
report in the case of each individual of the American Expeditionary Forces,
who became incapacitated while assigned to the British, whether in France or
Great Britain.^ A great amount of this work was carried on in cooperation
with the chief surgeon of base section No. 3 (the British Isles), and after March,
1918, most of these data were returned to him;** but prior to January 14, 1918,
the liaison officer discharged the duties of chief surgeon of this base section,
in addition to the others more properly pertaining to his office.^
The liaison officer cooperated in securing buildings and sites for hospitals,
especially before July 1, 1918.^ He investigated and reported upon properties
which were offered to the American Expeditionary Forces for hospitalization
purposes. It is of interest to note that in the course of these activities he found
it necessary to decline Windsor Castle, which was offered for our hospital
purposes by the King of England; without extensive alteration, that historic
structure could not be adapted to our needs." The King, therefore, offered to
build a hospital in the castle grounds, and this offer was accepted.^ The liaison
officer inspected other residences and estates offered us for hospitalization
purposes, and his reports led to the acceptance of a number of these." Sites
for the location of our base hospitals were thus selected throughout England,
and to these American casualties were sent " until in the spring of 1918, when
it became necessary to send a number of them to British hospitals.'
74
ADMINISTRATION, AMKKKAN EXPEDITIONARY FORCES
Another duty of the Haison officer was the selection of those ports where
American casualties from the continent would be received, the creation of
machinery for their reception, and the determination of their destination when
placed on British hospital trains.*' The ports selected included some of those
in the Channel, on the Thames, in Scotland, and in Ireland.*'
The liaison officer supervised the assignment in Great Britain of American
officers of the Medical, Dental, and Sanitary Corps for the study and treatment
of gassed cases, and of cardiac conditions, the study of the methods and standards
used in examinations of fliers of the Royal Air Force, of food and nutrition, and
of general, orthopedic and maxillofacial surgery.^ He investigated the treat-
ment and care during convalescence of injuries caused by mustard gas, and the
findings made in cases that came to autopsy.® He was liaison officer with the
Royal Air Force.® The chief surgeon, A. E. F., frequently asked that certain
specialists who were on duty in our hospitals which were under British con-
trol, be transferred to the service of our troops in France, and the liaison officer
was charged with transactions with the British authorities which would effect
the release of the specialists.® The needs thus created in British hospitals
he then sought to meet by assignment of untrained personnel.® Our six base
hospitals serving with the British were constantly in need of specialists and
replacements, and these needs w'ere handled by the liaison officer.®
The liaison officer not only cooperated in effecting the transfer to the Ameri-
can Expeditionary Forces of those American physicians who were serving in
the British Army and now sought transfer to ours, but he also advised the
director general of the British Army medical service, concerning the many
quacks, alleged physicians, and practitioners of various pathies who went to
England from the United States to enter the British Army.®
In addition to cooperating with the American Red Cross in its efforts to
assist personnel under his jurisdiction who had been captured, the liaison
officer cooperated with the representatives of that body in London.® He
assigned medical officers to hospitals established by that society, and was
designated by the commander in chief as personal adviser and aide to the
director general of the American Red Cross, when that officer conducted an
inspection tour through Great Britain.®
One of the duties of the liaison officer was the procurement in Great Britain
of supplies for our Medical Department, both before and after a purchasing
agent for this department was assigned to service in Great Britain.® In this
duty he not only promoted procurement from civil firms but also obtained
large quantities of supplies from the British Government.® The liaison officer
served as a member of the purchasing board for the Medical Department in
Great Britain, from October, 1917, until the middle of December of that vear.®
The British brought up for his consideration and action many questions
which pertained to the British Expeditionary Force in France, and to the
American Expeditionary Forces as entities.® The liaison officer was the channel
of communication between the chief surgeon, A. E. F., and the chief surgeon,
base section No. 3, on the one hand, and the Royal Army Medical Corps on the
other.® The chief surgeon's office, A. E. F., also transacted business with the
British through the British mission established at Tours, and through the liaison
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 75
officer pertaining to G-1, who represented the American Expeditionary Forces
at headquarters of the British Expeditionary Forces.®
Deaths occurring among American units or detached personnel serving
with the British were reported direct to the headquarters, American Expedi-
tionary Forces.^
After the base section No. 3 was organized and a chief surgeon was assigned
to it, the Haison officer continued to be charged with supervision of the six base
hospitals and casual American medical personnel assigned to the British, but
his activities did not extend to the medical organizations of our Second Corps.*^
That command which consisted of American troops serving under British con-
trol was provided with a corps surgeon who was directly responsible to the
chief surgeon, A. E. F., or in some matters to the latter's deputy at general
headquarters.®
The average personnel of the Medical Department, A. E. F., constantly
on duty with the British Army approximated 800 officers, 600 nurses, and 1,100
enlisted men.® On November 23, 1918, there were serving with the British, 888
officers, 1,311 enlisted men, 676 nurses, and 24 civilian employees.®
American Medical Department organizations which participated in the
North Russian expedition were under British command, but occupied, in
reference to the liaison officer with the British, a position comparable to that
of the base hospitals assigned to the British Expeditionary Force in France.®
The official methods of the Medical Department organizations of the North
Russia expedition were made to conform, therefore, to British requirements
in so far as they w^ere relevant to British control, but other reports and returns
conformed to American requirements.®
LIAISON WITH THE FRENCH MEDICAL SERVICE
The increasing number of American troops which entered the lines, mingled
with the French, brought the two armies into very close relationship, until
March, 1918, when under military exigencies the two services operated as one.^
The chief surgeon's office had to have a clear knowledge of the organization of
the French Army and especially that of its medical department, from the Min-
istry of War to the field sanitary units, for French methods required that
business be transacted only through definitely authorized agents.^ Therefore,
it was necessary that the Medical Department, A. E. F., maintain the closest
contact possible with the French authorities, for their cooperation was essential
in a number of matters including the development of our program for hospital
procurement.^
The French realized more clearly than had the Americans, this necessity
for close cooperation and provided liaison officers for every branch of endeavor.^
Very shortly after the arrival of the first American troops the French Govern-
ment established at the Ministry of War the special Franco-American bureau
with subbureaus, know^n as sections, wherever needed." It thus provided an
agency through which all matters affecting the two services could be studied
and handled. In the subsecretariat of state, French medical service, a sub-
section of this Franco-American service was established." Also, in this sub-
secretariat a special technical division charged with American hospitalization
76
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
was organized. The object of this latter division was to assist in every way
possible the procurement of hospitals, hospital sites, and medical supplies for
the American Expeditionary Forces, and to facilitate the transfer to our medical
service of those existing French hospital installations and buildings which our
service needed.^
Owing to the shortage of medical officers, the chief surgeon, A. E. F., was
unable to comply with the request of the French that he place one of his subordi-
nates as liaison officer in this Franco-American section but he did direct the
chief of the hospitalization division in his office to effect close liaison service
therewith, in addition to his other duties.** At this time when the great prob-
lems of the Medical Department were those pertaining to the hospitalization
and supply and were concerned almost exclusively with the Services of Supply,
this plan worked very satisfactorily.^
On August 25, 1917, in anticipation of the movement of General Head-
quarters of the American Expeditionary Forces to Chaumont, the chief surgeon
designated the purchasing officer for the Medical Department, in Paris, as
Haison officer for the French medical service,'" and on the same date requested
that a French officer be attached for liaison purposes to his own office after this
had been established at Chaumont."
Therefore, after the chief surgeon's office arrived at Chaumont an experi-
enced French medical officer was assigned to liaison service with it, but after
this officer had reported the French commander in chief required that he be
placed under his jurisdiction.'^ This the undersecretary refused to permit;
and as the French commander in chief would allow no French officer to remain
in the zone of the armies who was not entirely under his control, this liaison
officer was relieved.'^ The result was that the chief surgeon, A. E. F., lost a
valuable adviser, and the close and direct relations between his office and the
subsecretary of state, medical department, in Paris, were severed.'^
On September 15, 1917, the chief surgeon and the chief of the hospitalization
division of his office visited the French headquarters at Compeigne, for the
purpose of making arrangements concerning the transaction of business relating
to our Medical Department in the zone of the armies, and on the 17th they
held a conference in Paris to determine the manner in which the Medical
Department should transact business with the secretariat, now that our head-
quarters had moved into the zone of the armies.'^
After headquarters, A. E. F., were established at Chaumont, the French
high command established there a military mission which was organized with
the same bureaus as the French General Staff This organization provided a
medical section under a French medical officer, who was charged with trans-
action of all business of whatever nature affecting the Medical Department in
the zone of the armies.^ The chief of the hospitalization division in the chief
surgeon's office was designated liaison officer between that office and the
French mission.^
As questions pertaining to procurement of hospitals and other facilities were
of immediate concern to the Services of Supply, in whose jurisdiction base
hospitals and supply depots were being located in great numbers, it was expe-
dient that the chief surgeon of that command also be in close touch with the
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 77
French subsecretary of state, medical service.'^ The chief surgeon, A. E. F.,
therefore, notified the chief of the French mission at Chaumont, on October 19,
1917, that he had designated the chief surgeon. Services of Supply, as his
representative for all matters of Medical Department interest outside the zone
of the armies.'^ He also asked that a French liaison officer be attached to the
latter's office, which was then in Paris.'* This was done, and after headquarters
of the Services of Supply moved to Tours in January, 1918, a French liaison
officer was attached to the office of its chief surgeon there.''
On February 9, 1918,'^ in compliance with a request of the subsecretary of
state, medical service,'^ a senior medical officer of the American Expeditionary
Forces was assigned to liaison duties with his office, and other officers to each
of the 11 regions in which Americans were then conducting their most import-
ant activities.'®
The officer selected for this assignment as liaison officer with the subsecre-
tary of state, medical service, was the chief of the hospitalization division of
the chief surgeon's office, who was performing liaison duty with the French
mission at general headquarters.^ The cumulation of such duties upon one
individual was necessitated by the shortage of officers and, in fact, worked out
well, for the great majority of questions which required negotiations with the
French continued to pertain to procurement of hospitals and medical supplies.^
After the chief surgeon's office, A. E. F., moved to Tours, in March, 1918,'^
it transacted some business direct with the French mission established in that
city,'^ but contact was maintained chiefly through the officer referred to above,
who remained with general headquarters at Chaumont as representative of the
chief surgeon.^" Relieved from duty in the hospitalization division, he now in
addition to his other duties, maintained liaison between the Medical Depart-
ment, A. E. F., on the one hand, and, on the other, with the subsecretary of
state, medical service, in Paris, and the French mission at Chaumont.^ Part
of this duty was his supervision of the liaison effected by other medical officers
assigned to that duty, whether for armies, corps, or divisions in the field, or for
regional subsections in the Services of Supply.^
In compliance with a circular letter from the Minister of War, dated
December 30, 1917, Franco-American sections had been instituted in connec-
tion with the large French services.^' These sections were charged with the
study of all Franco-American affairs transmitted to them and the solution of
problems incident thereto.^'
Eventually, sections of the Franco-American service were established at
each headquarters of the military regions (approximately 20) into which France
was divided, and a local medical officer of the A. E. F. was assigned to each, in
addition to his other duties, as liaison officer for the chief surgeon.** All matters
of policy were determined between the Franco-American section in Paris, and
the chief surgeon's office, but, when policies had been declared the execution of
details conforming thereto was made a duty of the regional subsections.^ The
activities of these regional officers are discussed at greater length below.
The matters which the liaison officer for the Medical Department conducted
with the office of the subsecretary of state, medical service, may be classified as
follows (a) Procurement of French hospitals for the American Expeditionary
78
ADMINISTRATION', AMKHICAX KXI'KDITION A K V FORCES
Forces; (b) procureineiit of existing l)uildiiigs, such as hotels and schoolhouses,
for hospital purposes; (c) all questions of standard medical supplies obtained
from the French medical service; (d) the execution of contracts for the purchase
of sanitary formations from the French medical service, such as mobile hospitals
and mobile surgical units, etc. ; (e) formulation of policies regarding the exchange
of the necessary data covering American patients in French hospitals and French
patients in American hospitals; (f) formulation of policies regarding control of
communicable diseases, particularly with a view of protecting the French civil
population; (g) miscellaneous matters.
The above classification practically outlines the scope of duties which
devolved upon the American liaison officer with the French medical service.^'^
The matters which required the greatest amount of work were those connected
with procurement of hospitals of the American Expeditionary Forces, and the
hospital supplies which could be secured better in Europe than in the United
States. From the very beginning of our effort it was necessary that the
American Expeditionary Forces take over from the French certain hospitals
and their equipment, in order to meet the needs of arriving American troops,
and this need continued until our barrack hospitals could be constructed.^^ At
first the procedure for taking over these hospitals was by direct request upon the
office of the subsecretary of state, through the liaison officer attached to his
office. Later this duty was performed through the regional liaison officers for
the Medical Department.^ Each of these officers acted on all routine matters
as an intermediary between the local American authorities and the director
of the French medical service for the region concerned.'' Matters of policy
continued to be determined between the representative of the chief surgeon,
A. E. F., and the office of the subsecretary of state, medical service, in the
Ministry of War, but the details conforming thereto were carried out by the
regional liaison officers.^
As noted above. Franco- American sections were established as need arose
at headquarters of each of the 20 military administrative regions into which
France was divided.^ A medical officer of the American Expeditionary Forces
in each of these regions was accredited to the respective Franco-American
section estabhshed at headquarters of each, and, in his liaison duties, which he
discharged in addition to others, was under the control of the liaison officer for
the Medical Department.^
These officers were given definite rules concerning acquisition of hospital
sites and of buildings suitable for hospital purposes, the taking over of existing
French hospitals, and the coordination of the medical services of the two coun-
tries in many other respects, but the greater part of their duties was concerned
with hospitalization.^^ They were directed to maintain contact and cordial
relations with the regional medical director of the French Army, with whom
they conducted initial negotiations for the transfer of projects and installations;
to exert every effort to avoid friction; and to arrange with the medical director
the local policies which would guide them in future liaison activities.^ In
their instructions these officers were informed that the French had manifested
a desire to cooperate in every way possible and already had given us many
of their best hospitals. They familiarized themselves with all hospitalization
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 79
prospects in their regions in order that in emergencies appropriate request
could be made for their procurement.*^ From time to time they were directed
to inspect and report upon hospital properties made available by the French,
to conduct such investigations, as were prescribed, of certain projects or instal-
lations, and were given instructions concerning further development of the
liaison service.^ Also, they were guided by general orders concerning liaison.
They not only notified the chief surgeon, A. E. F., of their liaison activities but
also the chief surgeon, Services of Supply, until the office of the former absorbed
that of the latter in March, 1918, promptly furnishing the latter any hospitaliza-
tion data he desired and assisting him in the acquisition of buildings. The
liaison officer for the district of Paris was concerned with the proper distribution
of American patients in that jurisdiction, for certain hospitals had been desig-
nated for the reception of American wounded, and close cooperation with the
French was necessary in order that this distribution might be made to best
advantage.
Liaison in matters pertaining to sanitation and epidemiology of both civil
communities and military organizations was maintained, through the medical
officers of the French military mission at general headquarters, A. E. F., and
at headquarters. Services of Supply, and through the Franco-American sections
in each of the regions wherever American troops were stationed or through
which they passed. The French mission at headquarters. Services of Supply,
included a medical officer in direct liaison with the chief surgeon, A. E. F., and
suitable French liaison officers were assigned to duty with the chief surgeons
of sections of the Services of Supply, and with the commanding officers of a
few of the larger hospital centers. '■^^ The chief of the French skin and vene-
real service of each region was directly accredited to the American medical
service as liaison officer in all matters affecting his specialty. The technical
chiefs at the French headquarters of the several regions, were directed to coop-
erate with the local liaison officers of the American Expeditionary Forces in
matters aft'ecting the hygiene, epidemiology, and prophylaxis of American
troops.-*^ They were ordered to effect technical cooperation in the following
matters especially : (1) Study and survey of water supplies; (2) employ-
ment of all bacteriological laboratories by American medical officers in their
efforts to confirm the diagnosis of communicable diseases, detect carriers,
perform water analyses, etc.; (3) regular and constant receipt of information
concerning incidence of infectious diseases among American troops and measures
taken to control their spread; reciprocal notification to the American authori-
ties of all epidemics of any importance among French civil or military popula-
tions with note of preventive measures taken; '^^ (4) notification to the Medical
Department of the American Expeditionary Forces of localities quarantined
and released from quarantine. Study in collaboration with the chief medical
officers of hospital centers and of dermatovenereological subcenters, of all
questions concerning the treatment and prevention of venereal disease and
information of the Medical Department of all regulations, circular letters,
and notices concerning sanitation, epidemiology, and preventive measures.^^
In order to comply with these instructions the following reports were made
by the regional Franco-American sections Report every 10 days of all con-
13901—27 ii
80
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tagioiis diseases among American troops stationed in the region, including all
necessary precautions. Prompt notice to civil authorities of contagious
diseases occurring among American troops.^^ Monthly report by chiefs of
dermatovenereological centers and subcenters, including in a special chapter
all questions concerning venereal diseases occurring among American troops.^*
Monthly report by the assistant chief medical officer of the region or the tech-
nical adviser. This was addressed to the medical officer of the French military
mission at headquarters, Services of Supply, to be transmitted to the office of
the chief surgeon, A. E. F.^®
The Franco-American liaison was of considerable benefit and importance
in certain other technical professional matters; e. g., delivery of sera to Ameri-
can medical officers by French laboratories, sterilization, and analysis of
drinking water in railroad stations.^*
A French ministerial circular letter of October 18, 1919, provided for
collaboration of the American and French medical authorities in reports relative
to the bacteriological and chemical tests of water supplies along the railroad
lines traversed by troop convoys.^^
Just as liaison was established between the American and French Medical
Departments at American headquarters at Chaumont, at Tours, and at head-
quarters of the several French military regions, it was similarly maintained in
the field between the medical service of smaller organizations of American
troops and that of the medical service of the command with which they were
serving. Medical officers of American corps or divisions operating under the
control of one of the allied nations were designated, in addition to their other
duties, as liaison officers for the chief surgeon, A. E. F., between the medical
services of the troops concerned. Thus, on May 21, 1918, an American
medical officer was assigned as liaison officer for the medical service of the 1st
Division with whatever French force to which that division would be assigned,"
and the chief surgeon, American First Corps, on July 13, was made liaison
officer for the American Medical Department with the French Sixth Army
under whose tactical control that corps was then serving. Similarly, when
French divisions later served under American command, French medical offi-
cers of those commands maintained liaison with the chief surgeons of the
American corps and armies to which such divisions were assigned.^ This
liaison effected by our medical service with that of our allies in the field, the
chief surgeon supervised through his deputy at general headquarters.
VETERINARY LIAISON WITH THE FRENCH
On April 11, 1918, the chief surgeon, A. E. F., was directed to designate
two veterinary officers who would form, with two French veterinary officers,
a Franco-American veterinary mission which would be charged with investi-
gating and recommending measures to prevent or combat epidemics among
animals in France. A French veterinary inspector designated by the under-
secretary of state was charged by the latter with keeping this mission informed
of all epidemics that might occur in the vicinity of American troops. The
mission was to visit the organizations in which contagious diseases were reported
and suggest all prophylactic measures indicated by insanitary conditions.^*^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 81
The mission also was at the disposal of the veterinary inspector who was to
seek its advice and assign it to services in connection with any matters per-
taining to the French veterinary general inspectorate.^*' The undersecretary
suggested that the following duties of the French mission would be especially
useful:^" (1) Visiting American remount depots, both to ascertain the con-
dition of animals bought and the state of those places from a sanitary stand-
point. (2) Enforcing glanders prophylaxis by systematic use of malleiniza-
tion, as carried on in the French Army. (3) Furnishing the United States
Army with every information as to how to deal with diseases due to acclima-
tization of young horses, notably strangles and its complications. (4) Carry-
ing on antimange defense on a methodical basis through the use of chemical
products (sulphur and baths) and promptly initiating the construction of all
installations needed. (5) Providing for defense against the various sorts of
lymphangitis, in order to prevent spread of same, both in the United States and
the French Army. (6) Suggesting all measures to be taken in connection
with any other contagious disease that might be reported in the United States
Army. (7) In regard to the animal's food, the composition of rations, the use of
substitute foodstuffs, the making of summer and winter horseshoes, and giving
advice with a view^ to facilitating the proper maintenance of horse strength.
It was understood the mission should report every week on the work it
had done to the high American and French veterinary authorities to which it
was attached and should point out in special reports the improvements that
could be made in the organization and functioning of the veterinary service
in each army.^*'
It was later proposed by the French that the instructions for the mission
be made more definite, that it be made mandatory that this mission be con-
sulted in case of epidemics, and that when ordered to do so, or when it thought
such action necessary, it visit the organizations where contagious diseases were
reported and propose appropriate prophylactic measures.
On September 30, 1918, the chief surgeon, A. E. F., notified the chief of the
Franco-American veterinary mission that the value of the mission, operating
on the above lines, had ceased, but that it could be of great value if its activities
were directed into other channels.^^ He therefore requested that a French
veterinary officer be assigned as liaison officer in the chief surgeon's office,
A. E. F., and that one be assigned as liaison officer with, the assistant chief
veterinarian of the advance, intermediate and each base section, respectively,
and to each army.^^ The services of these officers were to be purely liaison
between the assistant chief veterinarian concerned and the local French veteri-
nary and civil authorities.^^ In conformity with this recommendation one
French veterinary officer was attached for liaison purposes to the chief of the
veterinary service, A. E. F., at Tours and another to the assistant chief of the
veterinary service in the advance section, at Nogent en Bassigny.^^ Others
were also assigned to the First, Second, and Third Armies,^* but the Franco-
American veterinary liaison mission with headquarters in Paris continued to
operate until several months after the beginning of the armistice.^^
The last French liaison officer on duty with the Medical Department,
A. E. F., was relieved on June 30, 1919.^«
82 ADMIXISTHATIOX, AMKRICAX EXPEDITIONAKV FORCES
LIAISON WITH THE ITALIAN MEDICAL SERVICE
Liaison with the ItaUan medical service was maintained through our chief
surgeon base section, No. 85 On November 23, 1918, 57 officers and 1,010
enhsted men of the American Expeditionary Forces were serving under the
control of the Itahan Arniy.^^
PERSONNEL
(July 28, 1917, to July 15, 1919)
LIAISON OFFICERS
WITH THE BRITISH ARMY
Col. Matthew A. De Laney, M. C.
Col. William J. L. Lyster, M. C.
WITH THE FRENCH ARMY
Col. Sanford A. Wadhams, M. C.
WITH THE ITALIAN ARMY'
Col. Elbert E. Persons, M. C.
REFERENCES
(1) Telegram from the chief of staff, A. E. F., to Maj. W. J. L. Lyster, M. C, June 9, 1917.
Subject: Liaison officer. On file. Record Room, S. G. O. (9795).
(2) Letter and memorandum from the chief surgeon, A. E. F., to the Surgeon General,
U. S. Army, June 11, 1917. Subject: American medical personnel serving with
British forces. On file. Record Room, S. G. O. (9795).
(3) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C., June 11, 1917,
Subject: Administration of American medical personnel serving with British service.
On file, Record Room, S. G. O. (9795).
(4) Letter from The Adjutant General of the Army, to Col. A. E. Bradley, M. C, American
Embassy, London, May 28, 1917. Subject: Designation as chief surgeon of the
United States forces in Europe. On file, Record Room, S. G. O. (9795).
(5) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, June 25, 1917.
Subject: Instructions. The administration of American medical personnel with
British in relation to A. E. F. On file, A. G. O., World War Division, chief surgeon's
files (201, Lyster, W. J. L.).
(6) Report from Col. M. A. Delaney, M. C, liaison officer with the Director General,
British Medical Service, to the Surgeon General, U. S. A., Februarj- 18, 1924. Subject:
Liaison activities with the British Medical Service. On file. Historical Division,
S. G. O.
(7) Report from Capt. Arthur Morehouse, San. Corps, to the Surgeon General, U. S. Army,
February 12, 1924. Subject: Summarized history of Army activities in base section
No. 3, England. On file. Historical Division, S. G. O.
(8) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to Mav 1, 1919.
On file, Historical Division, S. G. O.
(9) Wadhams, S. H., Col., M. C, and Tuttle, A. D., Col., M. C: Some of the early prob-
lems of the Medical Department, A. E. F. The Military Surgeon, Washington,
D. C, 1919, xlv. No. 6, 636.
(10) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., August 25,
1917. Subject: Liaison officer, with the French Service de Sante. On file, A G. 0.,
World War Division, chief surgeon's files (211.01).
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 83
(11) Letter from the chief surgeon, A. E. F., to Sous-Secretariat d'Etat da Service de Sante,
Premiere Division Technique, Hdpital Am4ricaine, Minister of War, France, August
25, 1917. Subject: Officer of liaison. On file, A. G. O., World War Division, chief
surgeon's files (211.01).
(12) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., September
2.3, 1917. Subject : War diary for the week of September 23, 1917. On file. Historical
Division, S. G. O.
(13) Letter from the chief surgeon, A. E. F., by direction of the commander in chief, A. E. F.,
to the chief, French mission, headquarters, A. E. F., October 19, 1917. Subject:
Liaison officer for the American Sanitary Service in Paris. On file, A. G. O., World
War Division, chief surgeon's files (211.01).
(14) Letter from the chief surgeon, A. E. F., to the chief, French miUtary mission, October
21, 1917. Subject: Appointment of liaison officer. On file, A. G. O. , World War
Division, chief surgeon's files (211.01).
(15) Letter from the Assistant Secretary of State of the Military Sanitary Service, to Col.
F. A. Winter, chief surgeon, line of communications, A. E. F., Tours, January 25,
1918. Subject: Detail of officer for service with chief surgeon, line of communica-
tions, Tours. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(16) Letter from the chief surgeon , A. E. F., by direction of the commander in chief, A. E. F.,
to the chief French Military mission, February 9, 1918. Subject: Appointment of
officers of the United States Army Medical Corps to act in liaison with French
authorities. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(17) Letter from the Sous-SecrMariat d'Etat du Service de Sante, to the Sous-SecrHariat d'Etat,
Presidence du Conseil, January (no date given). Subject: American officers to be
attached to French American services on sections. On file, A. G. O., World War Divi-
sion, chief surgeon's files (211.01).
(18) War Diary, chief surgeon's office, A. E. F., March 24, 1918. Copy on file, Historical
Division, S. G. O.
(19) Memorandum from the chief surgeon, A. E. F., to the French mission, headquarters,
S. O. S., June 28, 1919. Subject: Veterinary liaison officer. On file, A. G. O. , World
War Division, chief surgeon's files (211.01) .
(20) Letter from the chief surgeon, A. E. F., to Sous-Secretaire d'Etat du Service de Sante,
Section Franco-Americaine, French mission, G. H. Q., A. E. F., March 8, 1919.
Subject: Epidemic diseases in the A. E. F. On file, A. G. O., World War Division
chief surgeon's files (710).
(21) Report on the general survey of communicable diseases, A. E. F., October 7, 1921, by
Col. Haven Emerson, M. C. On file. Historical Division, S. G. O.
(22) Report from the commander in chief, A. E. F., to The Adjutant General of the Army,
March 26, 1919. Activities of G-1, Appendix 8, Report of liaison service (pages not
numbered). On file. General Headquarters, A. E. F. Records.
(23) Letter from the chief surgeon, A. E. F., to Maj. A. E. Schlanser, M. C, February 12,
1918. Subject: Appointment as liaison officer with French Medical Service; and
letter from the chief surgeon, A. E. F., to First Lieut. F. E. May, Interpreter Corps,
N. A., February 25, 1918. Subject: Liaison with French Medical Service. On file,
A. G. O., World War Division, chief surgeon's files (211.01).
(24) Memorandum from the chief surgeon, A. E. F., to Col. James A. Logan, jr., Q. M. C,
February 24, 1918. Subject: Liaison officer. On file, A. G. O., World War Division,
chief surgeon's files (211.01).
(25) Report from Col. Haven Emerson, M. C, to the chief surgeon, A. E. F., May 31, 1919.
Subject: Report of Division of Sanitation and Inspection, Medical Department,
A. E. F., on file. Historical Division, S. G. O.
(26) Reports and records of communicable diseases, October 7, 1921, by Col. Haven Emerson,
M. C. On file, Historical Division, S. G. O.
(27) Letter from commander in chief, A. E. F., to Lieut. Col. Paul C. Hutton, M. C, May 21,
1918. Subject: Liaison. On file, A. G. O., World War Division, chief surgeon's
files (211.01).
84
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(28) Letter from tlie chief of the French military mission with the A. E. F. to the com
mander in chief, A. E. F., Medical Department, July 13, 1918. Subject: Liaison
officer. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(29) Telegram from Col. James A. Logan, jr., Q. M. C, to the commanding general, A. E. F.,
April 11, 1918. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(30) Letter from the Undersecretary of State with Prime Minister to the commander in
chief, A. E. F., May 11, 1918. Subject: Liaison Franco- American veterinary
mission. On file, A. G. O., World War Division, chief surgeon's files (211.01).
(31) Letter from the chief of the directorate of the rear to the chief of G-4, general head-
quarters, September (no date), 1918. Subject: Franco-American veterinary mission.
On file, A. G. O., World War Division, chief surgeon's files (211.01).
(32) Letter from the chief surgeon, A. E. F., to chief of Franco- American veterinary liaison
mission, Paris, September 30, 1918. Subject: Franco-American Uaison mission.
On file, A. G. O., World War Division, chief surgeon's files (211.01).
(33) Letter from chief of French mission at headquarters, S. O. S., to the commanding general,
S. O. S., October 8, 1918. Subject: French veterinarians appointed to the A. E. F.
On file, A. G. O., World War Division, chief surgeon's files (211.01).
(34) Letter from the chief surgeon, A. E. F., to the Franco-American veterinary liaison mis-
sion, Paris, January 24, 1919. Subject: Assignment of French veterinarians to
Second American Army; and letter from the chief veterinarian, A. E. F., March
15, 1919. Subject: Liaison officers, first and third Armies. On file, A. G. 0.,
World War Division, chief surgeon's files (211.01).
(35) Letter from the chief of the Franco-American veterinary liaison mission to the chief
surgeon, A. E. F., January 14, 1919. Subject: American liaison officer. On file,
A. G. O., World War Division, chief surgeon's files (211.01).
(36) Memorandum from the chief surgeon, A. E. F., to the assistant chief of staff, G— 1, S. O. S.,
July 1, 1919. Subject: French liaison officer relieved from duty. On file, A. G. 0.,
World War Division, chief surgeon's files (211.01).
(37) Report of the activities of the Ambulance Service with the Italian Army (not dated),
by Col. E. E. Persons, M. C. On file, Historical Division, S. G. O.
CHAPTER IV
THE ADMINISTRATION DIVISION"
When the chief surgeon's office, A. E. F., was organized on July 28, 1917,
one of its divisions was that of records and correspondence. This division was
charged not only with central control of all communications entering and leav-
ing the office but also with certain elements of internal administration of the
office. The last mentioned duty later determined the name of this division.
The methods adopted for the care, control, and disposition of records,
and for office administration, were not the result of preliminary plans, for to a
large degree they were adaptations to necessities. It was soon determined
that a definite system of recording correspondence capable of expansion had to
be estabhshed, therefore, the War Department filing system was instituted
with such modifications as appeared necessary for its adaptation to the needs of
the Medical Department in time of war. This system adopted at this time was
never changed in principle. The procurement of equipment and supplies for
the current work and expansion of the chief surgeon's office became one of the
duties of this division, thus taking over services which had been performed
by several officers prior to its organization. One of the earhest duties of the
office staff had been to obtain office supplies and equipment. The three small
rooms at No. 17 Rue Constantine in which the office of the chief surgeon
first was located in June, 1917, were furnished by the French Government with a
few tables, desks, and chairs, which with several typewriters brought from the
United States, constituted the initial equipment of the chief surgeons' office.
The procurement of the additional furniture and equipment required when the
chief surgeon's office moved, in July, into the six rooms allotted it in the Hotel
St. Anne, was, in part, one of the earliest activities of the administration
division.
An exceptionally aggravating difficulty, which existed at first arose from
the fact that at that time no American post office service was provided, and
mail intended for personnel of the Medical Department was addressed in the
care of the chief surgeon. All of this mail found its way to the administration
division, where its importance and value were fully appreciated, but where
there was not force adequate to handle it. When the first officials of the
American post office arrived, some 10,000 letters had accumulated.
Another duty of the administration division was the improvisation of
such blank forms as were necessary, and provisions for the printing of these
and other documents. Often the division was embarrassed by the demands
for paper, and many expedients were utilized to conserve the supply. Old
envelopes were used for scratch paper, letterheads were cut in half for short
letters and memoranda. Small pieces were used whenever possible and both
sides of each sheet were used in mimeographing, multigraphing, printing,
etc., but despite all the efforts at economy the shortage in paper was always
serious.
» Entire chapter based on "Report on the administrative section of the chief surgeon's oflSce, A. E. F., undated,"
by Capt. R. A. Dickson, M. A. C. On file, Historical Division, S. G. O.
85
86
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Very early in the history of the American Expeditionary Forces the need
for clerical help in the chief surgeon's office hecaine very urgent. Soldier
clerks were drawn from the six base hospitals then serving with the British
and a few others were enlisted from among American citizens resident in France.
Difficulty in obtaining suitable clerical help continued after the chief surgeon's
office moved with headquarters to Chaumont, early in September of 1917.
However, while the chief surgeon's office was located at Chaumont the need
for clerks was gradually relieved, for during this time base hospitals began to
arrive in France; and as they could not promptly be located, their personnel
was available for transfer. Accordingly some of the stenographers and typists
from these units were assigned to the chief surgeon's office.
As the work continued to expand other personnel, commissioned, enlisted,
and civilian, were assigned to this office until their number eventually approxi-
mated 500 persons. The officer in charge of the administration division super-
vised the two officers who were in command of the two detachments into which
were grouped enlisted personnel assigned to the chief surgeon's office. One of
these officers also was in general charge of the civilian employees on duty in
the office.
In his procurement and care of office furniture and equipment the officer
at the head of this division was assisted by a property officer who was immedi-
ately accountable for all Government property in the chief surgeon's office.
Other officers under his jurisdiction were those engaged in the service of the
record room and library, and the officers who served by roster throughout the
night in the chief surgeon's office. Another of the duties discharged by the
chief of this division was the procurement of additional office space. Work
was increasing in a geometrical ratio and until after the armistice was signed
progressively greater expansions in accommodations were necessary.
It had been anticipated that the nine rooms assigned to the chief surgeon's
office in one of the French barracks at Chaumont would be ample for prospec-
tive needs, but they were soon outgrown and the problem of additional accom-
modations became very serious. This was solved as an incident to the transfer
of the chief surgeon's office to Tours, on March 21, 1918.
The extent to which personnel, records, office equipment, and supplies had
increased at Chaumont was evidenced by the fact that when the chief surgeon's
office moved to Tours an entire train was necessary for their transportation, in
contrast to one car which had been ample for the movement of the chief sur-
geon's office from Paris to Chaumont.
At Tours the chief surgeon's office occupied rooms in building No. 3 of the
French Barracks No. 66, but by September 1, 1918, it had so expanded that
the finance and accounts and the statistical divisions were moved to other
buildings.
No record was kept in detail of the vast amount of correspondence, reports ^
and returns which passed through the chief surgeon's office. It was decided
that the time necessary to count and tabulate the number of pieces of mail
could be used more advantageously otherwise. All these documents passed
through the record office. Incoming mail was opened in one office, taken to
the desk of the officer in charge of records and correspondence, and thence
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 87
distributed by him and his assistants to the different divisions of the chief
surgeon's office. Similarly, mail from the different divisions of the office, after
being signed by the respective chief, was concentrated here, examined, and sent
to the mailing room. By this means all the information passing in or out of
the office was so concentrated that the officer in charge of this division was
able to answer many inquiries coming over the phone or otherwise, without
reference to other divisions. This method also enabled him to follow up
many papers that might otherwise have been misplaced.
All telegrams were numbered beginning with No. 1 on the 1st of each month
so that any reply could refer to the number on this telegram and the sender
could be located without delay.
PERSONNEL °
(July 28, 1917, to July 15, 1919)
Lieut. Col. Robert A. Dickson, San. Corps, chief.
Maj. Arthur Morehouse, San. Corps.
Maj. Arthur W. Proctor, San. Corps.
Capt. William J. Fen ton, San. Corps.
Capt. Henry W. Kelly, San. Corps.
Capt. Frederick W. Mueller, jr., San. Corps.
Capt. Frank Steiner, San. Corps.
First Lieut. Orin F. Hallam, San. Corps.
First Lieut. Harry C. Hanford, San. Corps.
» In this list have been included the names of those who at one time or another were assigned to the division during
the period, July 28, 1917, to July 15, 1919.
There are two primary groups — the heads of the division or the section and the assistants. In each group names have
been arranged alphabetically, by grades, irrespective of chronological sequence of service.
CHAPTER V
THE PERSONNEL DIVISION
ACTIVITIES
After the office of tlie chief surgeon was organized on July 28, 1917, its
personnel division was charged with all matters having to do with personnel of
the several branches of the Medical Department, A. E. F.^ As in the Surgeon
General's office," this included all administrative control of their promotion
and assignment to station, and, in some instances, appointment.^ A dental
section of the personnel division was organized toward the end of August, 1917,
under the officer who was also dental surgeon for headquarters.^ The chief
of the Army Nurse Corps did not become a part of the personnel division in
the office of the chief surgeon, A. E. F., until that office moved to Tours in
March, 1918, when it absorbed the office of the chief surgeon. Services of
Supply, in which the chief of the Army Nurse Corps, A. E. F., theretofore had
been serving.^ The chief nurse then became the head of the Army Nurse
Corps section in the personnel division of the chief surgeon's office, A. E. F.^
Before August 29, 1918, officers and men pertaining to the veterinary service
were assigned to the remount service in the Quartermaster Department, and
until that date this personnel operated under that department.* Subsequent
thereto the members of the veterinary service were under the control of the
veterinary division which was then established in the chief surgeon's office.*
After the chief surgeon's office was fully organized the personnel belonging to
the dental, veterinary, and nursing services were, generally speaking, under
the administrative control of the chiefs of such services, and the head of the
personnel division exercised only an indirect supervision over their subordinates,
but requests for changes of assignment and other technical matters came to his
office as a phase of routine and in conformity with his general control.^
Though the personnel division of the chief surgeon's office eventually
exercised general administrative control, as outlined above, over all members of
the Medical Department in the American Expeditionary Forces, in certain
fields such responsibility was, in some degree at least, in subordinate offices.*
Thus before March 21, 1918, the personnel serving in the Services of Supply
was under the administrative control of the chief surgeon of that jurisdiction,
until his office was absorbed by that of the chief surgeon, A. E. F.* After the
chief surgeon's office, A. E. F., had moved to Tours its personnel division
maintained contact with the medical service in the zone of the armies through
the chief surgeon's representative at general headquarters.* In the several
armies Medical Department assignments were controlled by the respective army
surgeons. Authority was granted eventually to the director of professional
services to procure travel orders for consultants direct from the general head-
quarters,^ and the director of the division of laboratories and infectious diseases
» Consult Chap. Ill, Vol. I, of this history.
89
90
ad:ministrati()X, amkkk ax expeditionary forces
was authorized to request travel orders for his subordinates without reference
to the chief surgeon's office." With members of the Medical Department, who
were serving with one or another of our allies, the personnel division mamtamed
contact through the respective liaison officers accredited to the medical services
of those countries.8 Members of the sections of the United States Army
Ambulance Service, which were loaned to the French and Italian Govern-
ments, had a relationship with the chief surgeon's office in a few matters,
especially those pertaining to technical reports; but when some of these sections
were reloaned by those Governments to the United States, their members came
more directly under the control of the personnel division as elements of the
Medical Department, A. E. F., except in a very few matters; e. g., fragmenta-
tion of iinits.^ Authority for assignment of personnel within their jurisdiction,
and for promotion of enlisted men to certain grades, was granted the chief
surgeons of armies, corps, and divisions, to surgeons of territorial areas, and
the commanding officers of such Medical Department formations as hospital
centers.'"
A part of the Medical Department of the United States Navy, serving in the
American Expeditionary Forces, was under the control of the chief surgeon,
A. E. F., in conformity with the regulation which prescribed that when marines
were serving with the Army they would come under the jurisdiction of the
latter." Not only the medical officers and enlisted men on duty with the
marines, but also the personnel of Naval Base Hospital No. 1, assigned to their
service, therefore, came under the chief surgeon, A. E F." This personnel of
the Medical Department of the Navy increased from 5 officers and 34 enlisted
men in June, 1917, to 68 officers and 493 enlisted men in September, 1918, after
which month its strength gradually fell.^^ The highest number of its officers on
this duty was reached in January, 1919, when these totaled 12}^ This naval per-
sonnel included that on duty at Naval Base Hospital No. 1.^* located at Brest,
that serving with the marine bridge which formed a part of the 2d Division,'^
and four surgical teams. Naval Base Hospital No. 5, Brest, offered 200
beds to the Army but this was a purely naval institution in all other respects."
After the office of the chief surgeon, A. E. F., moved on March 21, 1918, to
Tours, orders affecting Medical Department personnel under the jurisdiction
of that command, were issued by headquarters, Services of Supply.^ Orders
affecting personnel in the zone of the armies, or on duty with the United States
Army Ambulance Service, were issued by general headquarters on request
of the personnel division of the chief surgeon's office or occasionally by tele-
phone on request of that division through the representative of the chief
surgeon with the general staff.^ More frequently in emergencies orders from
this source were obtained by telegraphic request upon the adjutant general,
A. E. F., at Chaumont.^
Headquarters of the special services — i. e., the professional services of the
Medical Department — were established in September, 1917, at Neufchateau.^
Here the professional services were directly under control of the chief surgeon's
office, until the reorganization of the American Expeditionary Forces in March,
1918, after which date the group was under concurrent jurisdiction of the
hospitalization division of that office at Tours and of the representative of the
ORGANIZATIOX AND ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 91
chief surgeon with the general staif, A. E. F., at Chaumont.* The consultants
supervised the professional work of the officers serving in their respective
specialties, and acted as agents of the personnel division, in so far as they
recommended assignments of the officers who were under their professional
supervision. Such recommendations were approved in practically all instances,
except that in some cases officers were held in certain positions for disciplinar}'
reasons.*
Orders issued on the recommendations of the senior consultants were at
first issued through the personnel division of the chief surgeon's office, but
later, because of the large increase in work involved, and in order to expedite
service, they were issued through the director of professional services stationed
at Chaumont who was authorized to procure them direct from general head-
quarters, A. E. F.* This led to complications at times because of the possi-
bility of general headquarters and headquarters. Services of Supply, issuing
conflicting orders concerning the same officer, but this system was otherwise
so generally advantageous that it was continued.*
Until the two offices were consolidated the personnel division in the office
of the chief surgeon, A. E. F., and in that of the chief surgeon, line of com-
munications, maintained very close contact.^ The personnel division of the
chief surgeon's office, line of communications, exercised control over all medical
personnel within its jurisdiction until January, 1918, when this authority was
decentralized, the surgeons of the several territorial sections of the American
Expeditionary Forces then assuming supervision of all medical personnel
within their respective borders, except that serving at base hospitals.^
Replacements were handled entirely through the Services of Supply.* A
medical casual depot at Blois was planned and practically organized when it
was taken over as a casual officers' depot.* It continued, however, to receive
and distribute Medical Department casuals until July, 1918, when this service
was transferred to the 1st Depot Division at St. Aignan.* This transfer was
made with a view of establishing a short course of training in field work at the
1st Depot Division, but it was never possible to carry out this plan because of
the constant shortage of Medical Department enlisted personnel which neces-
sitated the prompt use of all available men, the longest stay in the depot being
not more than two weeks.* The transfer was a disadvantage, since it occasioned
some delay in getting officers and men to points where they were needed at
once. This delay was due chiefly to lack of transportation.*
One of the greatest difficulties encountered by the personnel division of the
chief surgeon's office was that of keeping record of the stations of officers, nurses,
and men.* This difficulty was due to delays or losses of documents in the
mail, carelessness in rendering reports, and similar causes.* Perhaps the great-
est factor occasioning this difficulty was the fact that under general orders,
A. E. F., daily change reports were rendered direct to the central records
office, and many officers thought that these records were forwarded to the
chief surgeon.* It w^as not until after the armistice had been signed, w^hen
service became somewhat more settled, that it was possible to correct and
complete records, and even at the best there was always uncertainty concerning
the actual location of many officers, nurses, and enlisted men.* During the
92
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
suinmer of 1918 orders were issued that all personnel records were to l)e kept
hy the central records office and that no staff department should retain any
of them.-* This order was the result of the belief that centralization of records
was the only efficient method, and it undoubtedly would have prevented
duplication of them; but it was thought at that time by the chief surgeon's
office that such action would have utterly disrupted the medical service/
In point of fact the order was never carried into effect, and records of Medical
Department personnel were retained in the personnel division of the chief
surgeon's office until the end of the war.*
It was much more difficult to obtain accurate records of the casual officers
assigned to the British Expeditionary Force in France who arrived in the
period June to September, 1917, than the records of those on duty with Base
Hospitals Nos. 2, 4, 5, 10, 12, and 21 which had been attached to the British
in May and June of that year.'' Officers connected with these hospitals
were in much closer contact w ith the American Army than those casual officers
assigned to purely British units."* There was great difficulty at first in reaching
these latter officers, and because of their ignorance of regulations, general
orders, etc., they very seldom reported change of status.* In many cases
officers served with the British for months before the chief surgeon's office
had record of them, and in general it w^as difficult to obtain from them personal
reports.*
It was also very difficult to obtain recommendations for promotions for
officers serving with the British, and many of those concerned came to feel
that the Medical Department was not sufficiently interested in the matter.*
It would have been advantageous had there been a Medical Department
representative attached to the British headquarters in France for the purpose
of keeping in touch with these casual medical officers and of informing them of
the various orders which might affect their status.* The chief surgeon of the
American Second Corps was in liaison with headquarters, British Expeditionary
Force in France, but only in so far as corps interests were concerned.*
STRENGTH OF MEDICAL DEPARTMENT PERSONNEL
Personnel of the Medical Department increased from 7 officers and about
twice that number of clerks (including 2 enlisted men) in June, 1917,'^ to
a maximum of 174,083 on January 11, 1918,^^ but this great expansion was
effected only after repeated urgent requisitions.^^ A most important function
of the personnel division was to provide personnel to keep activities of the
Medical Department up to standard despite a constantly increasing shortage
of Medical Department personnel,* especially of officers and nurses.'^"
The acute needs of the Medical Department for personnel were consid-
erably relieved by the cessation of hostilities, and by the splitting up of two
depot and four combat divisions.^*' On November 16, 1918, a memorandum
was submitted to the effect that no more Medical Department units from
the United States were desired, but that there was need for the following
personnel of that department as casuals: 200 medical officers; 125 officers,
Dental Corps; 41 officers, Veterinary Corps; 1,500 nurses; 2,000 enlisted men,
" For details concerning shortage of Medical Department personnel consult Chap. I, Vol. VIII, of this history.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 93
Medical Department; and approximately 2,722 enlisted men of the Veterinary
Corps. The total personnel of the Medical Department in Europe on that
date was 15,407 officers, 8,593 nurses, and 126,281 enlisted men of whom
944 officers, 656 nurses, and 1,314 men were serving with the British. Arrival
of additional personnel and the decrease in the number of admissions led
to a slight surplus in Medical Department personnel for the whole A. E. F.,
but it was soon absorbed through the return of officers and men to the United
States."
By November 30, 1918, Medical Department personnel totaled 163,841
officers, nurses, and enlisted men; i. e. 8.6 per cent of the American Expedi-
tionaTy Forces.
The following tabulation of Medical Department personnel shows the
bimonthly totals from June 1 to November 30, 1918.* In some cases these
totals are only approximate, as reports of arrivals of personnel were often
delayed in the mails.*
OfiBcers
Nurses
Enlisted
men
June 1, 1918 -
5, 198
9,601
14, 483
17, 487
2,539
4,735
7, 522
8,951
30, 674
67, 140
104, 557
137, 403
Aug. 3, 1918
Oct. 5, 1918._ _. ---
Nov. 30, 1918_
Medical Department personnel pertaining to the Navy also served in the
American Expeditionary Forces supplementing that of the Army. In Novem-
ber, 1918, this personnel numbered 62 officers and 416 enlisted men. The
highest number of officers, nurses, and enlisted men reported severally in the
American Expeditionary Forces at any time was as follows:* Officers, 18,146;
nurses, 10,081; enlisted men, 145,815.
Totals were not reached by the foregoing classes of personnel simultane-
ously. The highest grand total of Medical Department personnel collectively
was reported as follows under date of January 11, 1919.'^
Officers 17, 767
Nurses 9, 994
Enlisted men 145, 815
Civilian employees 507
Total 174,083
These totals should actually show as of the first week in December as there
were no Medical Department arrivals subsequent to that date, but because
of delay in receiving reports the full strength was not recorded finally until
the week ending January 11, 1919.^^
94
ADMIMSTKATIOX. AMERICAN EXPEDITIONARY FORCES
The grades held by this personnel and the branches of the service to
which the members therein pertained were as follows:
Table 1. — Medical Department personnel, American Expeditionar)/ Forces, January 11, 1919'^
WITH UNITED STATES
ARMY
Officers:
M. C...
S. C...
D. C...
V. C...
A. A. S.
Soldiers
Nurses
Civilians. . .
Total.
WITH BRITISH
Officers:
M. C.
S. C
D. C.
Soldiers...
Nurses
Civilians.
Total.
WITH FRENCH
Officers:
M. C_
S. C
D. C.
A. A. S
Soldiers
Total.
WITH ITALIANS
Officers:
M. C.
S. C
D. C
A. A. S
Soldiers..
Total
Grand total.
Weekly net loss,.
Weekly net gain.
Briga-
dier
gen-
erals
Colo-
nels
Lieu-
ten-
ant
colo-
nels
102
302
1
Majors
1,409
14
42
52
Cap-
tains
4,315
144
321
107
1
203
3
5
First
lieu-
ten-
ants
Sec-
ond
lieu-
ten-
ants
6,672
442
1,430
330
27
Total
officers
12,803
1,183
1,805
885
28
624
6
4
16,704
5
2
111
Total
enlisted
men
139, 788
1,313
Total
nurses
9,455
9, 455
539
539
3,704
3,704
1,010
,994
63
Total
civil-
ians
492
Grand
total
12,803
1,183
1,805
885
28
139, 788
9,455
-492
166,439
859
14
11
1,313
539
15
2,751
5
2
111
3,704
3,803
18
1
1
33
1,010
483
» Includes seven contract surgeons.
The work of the personnel division increased during December, 1918, because
of the large number of applications for immediate return to the United States
for discharge.* It w as estimated that 6,000 of these applications were received,
70 per cent of them from officers who had arrived overseas after September 1,
1918.* On December 2, in Circular No. 52, the chief surgeon issued instructions
to personnel concerning their return to the United States. Many casual officers
were released shortly after the beginning of the armistice, mainly for the pur-
pose of returning to the United States for discharge because of their affiliation
with colleges.* On account of the number of these releases it became necessary
to hold many other officers also desiring immediate return.*
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 95
General Orders, No. 4, G. H. Q., A. E. F., January 4, 1919, directed that
individuals would not be discharged in Europe without specific authority — in
each case from headquarters, A. E. F. If applications for discharge in Europe
were approved, individuals seeking such discharge were to be sent to the dis-
charge camp, St. Aignan. Other instructions concerning return to the United
States or discharge in Europe were published during the same month by General
Orders, No. 17, G. H. Q., A. E. F., January 25, 1919, and General Orders,
No. 20, G. H. Q., A. E. F., January 30, 1919, and by other later orders issued
by headquarters of the American Expeditionary Forces, or of the Services of
Supply. Instructions on the subject were also published in Embarkation
orders issued as a separate file, by headquarters, Services of Supply.
Release of a large number of base hospitals for return to the United States
within a few weeks after the beginning of the armistice, necessitated removing
certain of the junior officers from each of these units, in order to supply demands
for personnel from the army of occupation and from the various base sections,
and also to replace some officers of long service in the American Expeditionary
Forces w^ho had urgent reasons for return to the United States.^
By the middle of January, the weekly net loss of officers had reached 400,
and after that date it ran from 100 to 600 each week.* On March 1, it was
reported that the drain on the Medical Department personnel, because of
attendance at various universities, had again created a somewhat difficult situa-
tion.* A large number of applications for return to the United States were now
being disapproved except in unusual cases.* The movement of personnel
belonging to base hospitals was increasing, but it was necessary to retain at
least 50 per cent of the officers of those units which had been in France less than
one year, and assign them to other organizations.* By March, personnel was
returning to the United States at the rate of 300 officers, 300 nurses, and 2,000
enlisted men per week.^^
The entire United States Army Ambulance Service on duty with the
Italian forces was returned to the United States about April 1, 1919.*
On April 26, 1919, when about one-half of the American Expeditionary
Forces had been returned to the United States, the Medical Department per-
sonnel remaining in France was : *
Officers 12, 544
Nurses 6, 238
Enlisted men 21, 351
Civilians 347
By May 3 1 , the figures were as follows : * •
Officers 9, 7 6
Nurses 4, 837
Enlisted men 95, 957
Civilians 243
13901—27 7
96 ADMINISTRATION, AMEKK AN EXPEDITIUNAHV FORCES
On May 31, only one medical officer remained on duty with the British
Expeditionary Forces.^ By July 12 the personnel status of the Medical De-
partment was as follows:'^
Table 2. — Medical Department personnel, American Expeditionary Forces, July 12, 1919
Briga-
generals
Colo-
nels
Lieu-
tenant
colo-
nels
Mrtjors
Cap-
tains
First
lieu-
tenants
Sec-
ond-
lieu-
tenants
Total
officers
Total
enlisted
Total
nurses
Total
civil-
ians
Grand
total
WITH UNITED STATES
ARMY
Officers;
M. C
3
62
134
3
10
2
2
571
38
30
12
2
1,913
188
176
38
1
1,318
187
201
89
10
4,001
635
422
213
15
4, 001
635
422
213
15
27,846
2,239
157
S. C ----
219
D. C.
5
V. C
72
A. A. S
t
27, 846
2,239
-157
Total
5, 286
27, 846
2, 239
157
35,528
LOSSES SINCE LAST
REPORT
Officers:
M. C
3
10
92
4
10
2
145
7
37
4
1
95
11
48
2
2
345
37
96
16
3
345
37
96
16
3
24, 583
473
19
S. C
15
D. C
1
2
V. C..._
6
A. A. S-..
24, 583
473
1
19
Weekly net loss -
497
24, 583
473
19
25, 572
° Includes two contract surgeons.
The personnel status on August 31, when the American Expeditionary
Forces was succeeded by the American forces in France and the American forces
in Germany was as follows:
Table 3. — Consolidated daily field report of Medical Department personnel, S. 0. S.,
August 31, 1919
Officers
Enlisted men
Nurses
Med-
ical
Corps
San-
itary
Corps
Den-
tal
Corps
Vet-
eri-
nary
Corps
Mas-
ter
hos-
pital
ser-
geant
Hos-
pital
ser-
geant
Ser-
geant
first
class
Ser-
geants
Cor-
porals
Cooks
Wag-
oners
Pri-
vates
first
class
Pri-
vates
Total
en-
listed
Base Section No. 1--.
Base Section No. 2
Base Section No. 5
Advance section
Intermediate section-
District of Paris
36
25
127
25
13
19
16
7
2
5
14
1
2
2
2
7
6
4
16
5
6
4
2
2
6
5
1
1
1
5
1
2
6
2
3
3
4
8
3
7
6
1
10
25
21
63
5
9
9
10
10
35
30
146
19
9
15
14
6
24
23
63
5
5
11
4
16
11
102
3
5
4
9
15
2
81
1
1
89
93
648
49
29
39
45
4
81
74
482
66
38
39
11
289
258
1,598
1.54
98
123
104
37
9
20
98
18
15
30
12
1
Arrondisementof
Tours -
1
Office of chief surgeon-
Total
268
35
43
15
20
37
150
274
142
150
101
996
791
2,661
203
OKGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 97
PROMOTIONS
Though the promotion section of the chief surgeon's office was never under
the direct control of the personnel division, it is discussed at this point because
of its close association therewith.* This very important duty was under the
immediate control of the executive assistant to the chief surgeon, who formu-
lated the general plan for promotion, as prescribed in Circular No. 3, chief sur-
geon's office, and who gave this subject his immediate attention.^ He was
assisted in this service by a commissioned officer who was engaged in no other
duty.^
Early in the existence of the American Expeditionary Forces promotions
were made by the War Department upon the recommendation of the chief
surgeon and the Surgeon General, but this system was later abandoned and
all promotions in the Medical Department had to be approved by the com-
mander in chief.*
The need for making promotions in the Medical Corps of the American
Expeditionary Forces was especially urgent because most Medical Reserve
Corps officers were commissioned in the lowest grade (first lieutenants), origi-
nally the only grade provided under the law.* Among these were capable men
who had been in the practice of medicine 15 or 20 years. It was the intention
of the Surgeon General that these officers be given prompt promotion as soon
as their fitness for positions of increased responsibility was demonstrated; but
the machinery for promotion presented unexpected difficulties in the American
Expeditionary Forces, and for this reason the proportion of lieutenants at the
cessation of hostilities was about 60 per cent, instead of the 14 per cent pro-
vided by law.*
It is certain that many of the medical officers, serving with the British
especially, did not receive the promotions to which the law and the character
of their services entitled them.* They failed to get merited promotions, because,
in addition to the obstacles, delays, and accidents which characterized the
history of promotions of Reserve Corps officers serving under the immediate
jurisdiction of the American Expeditionary Forces, there were the added delays
incident to mail communications with the British Expeditionary Force, and the;
great difficulty of getting from the nine hundred or more officers on duty with
the British, the reports of "Character of service and qualifications" upon which
was based the roster which determined their promotions up to and including
the rank of major.*
Very few promotions were made during the first 10 months of the American
Expeditionary Forces.* Those proposed by the chief surgeon were disapproved,
as a rule, on the ground that a definite and methodical scheme of promotion
which would do justice to all, as nearly as possible, should be presented before
the commander in chief would be willing to make promotions except in very
special cases.* A scheme was finally worked out and presented to the command-
ing general, Services of Supply, on May 17, 1918, by whom it was forwarded
on May 19 with the following indorsement:
Heretofore I have generally disapproved recommendations for promotions in the Medical
Corps because they have come as isolated cases and presented no facts by which a reasonable
judgment could be formed as to the relative merits of the particular case, in comparison with
98
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the entire body of medical officers.* As this paper presents a i)lan wliich appears to me to
be comprehensive, legal, and reasonable, I approve of it and reconinicnd that it be adopted
as the basis for promotions of officers in this corps serving witli the American Expeditionary
Forces in Europe.*
The plan in question is given in Circular No. 36, chief surgeon's office, June
11, 1918, which is reproduced in the appendix of this volume. It was formally
approved by the commander in chief June 27, 1918.^ The first list of officers
recommended for promotion under it was forwarded on June 15, and five other
lists in July.* Later it was learned that these lists were not forwarded from
general headquarters until about August 10.* After that date lists sent in were
forwarded much more promptly.* As was true in other branches of the service,
promotions of lieutenants were not cabled to Washington but were sent by
courier, and even in the case of those recommended for promotion to higher
grades, the inevitable delays in the War Department made the process of get-
ting them through very slow.*
On September 4 the chief surgeon in common with other administrative
chiefs, was informed by the adjutant general, A. E. F., that no more promotion
lists were to be forwarded to Washington, as a new War Department general
order on the subject of promotions (General Orders, No. 78, War Department,
August 22, 1918) was en route from the United States.* It was hoped that this
order, which authorized the commander in chief, A. E. F., to make promotions up
to and including the grade of colonel (subject to confirmation by the War De-
partment), would greatly simplify and expedite promotions in the American
Expeditionary Forces, but this expectation was not realized, the opinion having
been advanced that in order to determine the question whether vacancies existed,
an approved table of organization was necessary.* On September 20 the chief
surgeon, A. E. F., wrote to the adjutant general, A. E. F., that as the law provided
that there should be a certain proportion of medical officers in each grade,
the number of these vacancies could readily be determined by applying the
proportions to the total number of medical officers in the American Expedi-
tionary Forces.* He added that an agreement had been made with the Surgeon
General, by which the commander in chief, A. E. F., could make promotions
up to the authorized proportion in each grade for the medical officers in the
American Expeditionary Forces.* These proportions, as established in Bulletin
59, general headquarters, A. E. F., August 16, 1918, were as follows for the
Medical and Dental Corps and presumably for the Veterinary Corps:* Colonel,
3.16; lieutenant col., 5.42; major, 23.70; captain, 53.90; first lieutenant, 13.82.*
The strength of the Sanitary Corps was 1 per 1,000 of the total strength of
the military forces, the number in each grade being proportional to the number
authorized by law for the corresponding grades of the Medical Corps.* No
grade above that of major was authorized by this order.* To this the adjutant
general, A. E. F., replied as follows on September 24:*
It will be necessary to have the War Department approve the aggreement between
the Surgeon General and the chief surgeon before the commander in chief will be authorized
to promote by temporary appointment, subject to confirmation by the War Department,
except where there is a vacancy in a table of organization authorized by the W^ar Department.
The question of the applicability of General Orders, No. 78, to the Medical
Department of the American Expeditionary Force was then taken up and
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 99
was referred to the War Department by the commander in chief in a cable
dated October 11.* To this the Chief of Stafl" replied on October 19, stating
that this order did not apply to the Medical Department, but it was learned
later that the negative in this cable reply was an error in coding.* When
the matter was again presented by the commander in chief, on October 28,
for reconsideration, he was informed by cable of November 5 that his request
for authority to promote medical officers was approved.* The chief surgeon
was informed on November 7 of this decision, but four days later the armistice
was signed and all temporary promotions were stopped.* The best use possible
was made of this short period by securing 680 promotions, but there remained
about 6,500 vacancies for men who were entitled to promotion by law and
by the character of their service.*
On December 9, 1918, the following estimate of Medical Corps officers
on duty in the American Expeditionary Forces, the legal allow^ances and
vacancies on a basis of 1,500,000 men was formulated by the representative
of the chief surgeon with the general staff.^^
ALLOWANCE
Legal
percentage
Basis,
1,500,000
On duty,
American
Expedi-
tionary
Forces
116
333
1,543
4,608
7, 432
Vacancies
Colonel -
3. 16
5. 42
23. 70
53. 90
13. 82
332
569
2, 489
5, 660
1,450
116
236
946
1,052
1 5, 982
Lieutenant colonel ---
Major -
Captain _
First lieutenant -
100. 00
10, 500
14, 032
> E.xcess.
On January 15, 1919, a list of recommendations w^as forwarded for pro-
motions, including 85 lieutenant colonels to the grade of colonel, 282 majors to
the grade of lieutenant colonel, 932 captains to the grade of major, and 2,457
lieutenants to the grade of captain.* These were approved and published in
orders on February 17, 1919.* This list did not by any means exhaust
the possibihties, as there yet remained the following vacancies:* 241 in the
grade of colonel, 293 in the grade of lieutenant colonel, 1,151 in the grade of
major, and 1,323 in the grade of captain. The regular officers recommended
on this list were not promoted until about May 1, 1919.* Another list of 1,171
names received favorable action on May 2, 1919, but several hundred deserving
officers whose active service dated from 1917 remained unpromoted when the
chief surgeon was notified that no further recommendations should be for-
warded.* In most of these instances the recommendations had not been
forwarded at an earlier date because the medical officers whose duty it was to
forward the reports of character of service and qualifications had failed to give
the necessary data which were called for by the scheme of promotion, such as
age, length of active service, date of last promotion.*
The following table shows the larger fists of recommendations for promo-
tion made by the chief surgeon, and favorably acted upon by the War Depart-
ment or general headquarters, A. E. F.:*
100
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Recommended
1918
May 1".
June 15.
June 21 .
July 6..
July 15.
July 18.
July 19.
July 29.
Aug. 5--
Aug. 12.
Aug. 21.
Sept. 4..
Oct. 10.
Oct. 27..
Nov.
1919
Jan. 15..
Apr. 19.
To-P- Tomajor
120
36
74
82
129
49
.58
261
2,290
764
33
15
63
54
52
24
27
136
807
321
To lieu-
tenant
colonel
225
83
3,911
1,613
To colo-
nel
Total
Where promoted
112
21
1
103
24
11
2
161
51
137
136
181
136
141
403
3, 391
1, 171
6,182
War Department.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
General headquarters
Do.
Do.
Do.
Do.
Many of the officers recommended for promotion in the list of January 15,
1919, did not receive it because of delay in announcing the promotions and the
fact that before this was accomplished these officers had sailed for the United
St ates.*
Similarly, of those officers whose promotions were announced on February
17, 1919, 419 officers did not notify the personnel division of the chief surgeon's
office or general headquarters of their acceptance of commission, the majority
of them having sailed for the United States within a very few days of the date
they would have received their promotions.*
Delays in promotion were attributed by the chief surgeon to the follow-
ing circumstances: Delays in the personnel section, general headquarters,
A. E. F.; delay due to transmission to Washington, and in securing prompt
action there; delay of two months due to discussion concerning applicability
of General Orders, No. 78, War Department, 1918, to the Medical Corps;
discontinuance of promotion for some months after the armistice began.
THE SANITARY CORPS
Under laws enacted prior to the World War none except a person holding
a doctorate degree in medicine or denistry could be commissioned in the Medi-
cal Department; however, after we entered the war, and in order to meet the
need for sanitary engineers, chemists, administrators, etc., a new branch of
the Medical Department, entitled the Sanitary Corps, was organized under
the authority granted by the act of May 18, 1917.^^ The officer personnel of
this new corps was not to exceed one-tenth of 1 per cent of the total Army
strength; the number of enlisted men was to be determined by the Secretary
of War.^^ The number of officers in the several grades was to be proportionate
to that of corresponding grades of the Medical Corps, but, as originally pre-
scribed, no grades were provided for in the Sanitary Corps above the grade of
major.
STRENGTH
The Sanitary Corps in the Americn Expeditionary Forces comprised
officers, already commissioned, who were sent to France, and others commis-
sioned overseas. 2^ In order that vacancies in this corps would not all be filled
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 101
by men sent from the United States, on May 25, 1918, General Pershing noti-
fied the Surgeon General that he desired to hold vacancies in the Sanitary
Corps, in units already overseas, for men to be promoted from such units,
and that he did not wish to have additional Sanitary Corps officers sent to
France to fill the positions." Eventually, this arrangement brought up the
question as to how many persons could be commissioned in the Sanitary Corps
in France, so on October 30, 1918, General Pershing sent another cablegram
to the War Department, in which it was asked how the strength of the Sani-
tary Corps was to be determined and what proportion would be allowed in
each grade. On November 8, War Department answered to the effect that
under General Orders, No. 80, War Department, 1917, the allowances of the
Sanitary Corps were colonels, 1; lieutenant colonels, 5; majors. 111; captains,
1)36; first lieutenants, 975; second lieutenants, 802.^^
The strength of this corps increased gradually until 1,185 of its officers
were serving in the American Expeditionary Forces on January 4, 1919.^'
This number amounted to 7.03 per cent of all officers of the Medical Depart-
ment, A. E. F}'
PROJECT FO*R TRANSFERRING CERTAIN AMERICAN RED CROSS
PERSONNEL TO SANITARY CORPS
On October 3, 1918, the commander in chief notified the Secretary of
War that the American Red Cross representative and the chief surgeon, A.
E. F., desired that such parts of the American Red Cross personnel as were
serving the armies in Europe be incorporated in the Sanitary Corps.^° The
commander in chief approved this policy in order that coordination might be
perfected, and requested that the Sanitary Corps of the xA.rmy be enlarged
sufficiently to permit such absorption, that he be authorized to enlist American
Red Cross personnel and to make appointments of American Red Cross officers
in appropriate grades of the Sanitary Corps.^" This authorization he asked
for was to include 1 colonel, 2 lieutenant colonels, and others in grades propor-
tional to those provided for in existing orders. The number of officers to be
commissioned under the authority thus requested would not exceed 750 and
the number of enlisted men would not exceed 1,500.^° It was not intended
that this absorption of American Red Cross personnel would change materi-
ally the duties in which that organization was engaged.^^
On October 11, the commander in chief further cabled that it was not
intended that American Red Cross officers should be appointed in the Sanitary
Corps unless they were mentally, morally, and physically qualified. He
added that commissioning officers from the American Red Cross should not
give members of other societies grounds for urging like action for their own
members, for the reason that the American Red Cross personnel serving the
armies were performing the same duties as was the Medical Department of the
Army.^^ He expected that American Red Cross officers appointed in the
Sanitary Corps would remain, in general, in their then duties but would be
subject to general assignment.^^
This project for the transfer of American Red Cross personnel to the
Sanitary Corps never materialized.^^
102
ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
DUTIES
The majority of the officers of the Sanitary Corps in the American Expedi-
tionary Forces were assigned to hospitals where they discharged such duties
as adjutant, mess officer, and property officer. On the whole, however, the
duties discharged by officers of the Sanitary Corps were quite diversified,
comprising, in addition to those referred to above, duties as accountants,
architects, interpreters, opticians, those connected with certain phases of gas
defense, and in connection with rodent destruction.^^
PROMOTIONS
In this corps, as in other branches of the Medical Department, promotions
were not commensurate with vacancies. On April 19, 1919, to cite but one
illustration, the chief surgeon recommended that promotions be made in the
Sanitary Corps to fill the vancancies then existing.^^ Those in the grade of
lieutenant colonel then numbered 59; major, 126; captain, 162; while excess
proportions of officers in the grade of first and second lieutenants, respec-
tivelv, were 22 and 327.^^
CONTRACT SURGEONS
The few contract surgeons in the service of the Medical Department
overseas, like medical officers, were directly under the jurisdiction of the chief
of the personnel division, and not of any separate section of his office.* The
general circumstances in which they were employed are discussed in the first
volume of this history. The authority enjoyed by the Surgeon General to
employ contract surgeons subject to the approval of the Secretary of War ^*
was also delegated to the chief surgeon, A. E. F.^^ Among their number were
women who were engaged as anesthetists, laboratory technicians, and in certain
other duties as required. The total number of men and women serving as
contract surgeons in the American Expeditionary Forces was 13, of which
number there were 2 men and 11 women.^^
PERSONNEL"
(July 28, 1917, to July 15, 1919)
Maj. Gen. M. W. Ireland, M. C, chief.
Col. E. M. Welles, M. C, chief.
Col. W. H. Thearle, M. C.
Lieut. Col. J. S. Coulter, M. C.
Lieut. Col. J. W. Meehan, M. C.
Maj. W. Denison, M. C.
Maj. Clarence S. Ketcham, M. C.
Maj. E. H. Rogers, San. Corps.
Capt. J. H. Mael, San. Corps.
Capt. P. J. Skelly, San. Corps.
First Lieut. A. S. Callaway, San. Corps.
First Lieut. D. E. Mannix, San. Corps.
" In this list have been included the names of those who at one time or another were assigned to the division
dm-ing the period July 28, 1917, to July 15, 1919.
There are two primary groups — the heads of the division or the section and the assistants. In each group names
have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 103
REFERENCES
(1) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 28,
1917. Subject: Weekly war diary. On file. Historical Division, S. G. O.
(2) War diary, chief surgeon's office, A. E. F., September 5, 1917.
(3) War diary, chief surgeon's office, A. E. F., March 24, 1918.
(4) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file.
Historical Division, S. G. O.
(5) Report from Maj. Edward M. Welles, jr., M. C., chief of personnel division, A. E. F.,
to the Surgeon General, U. S. Army, April 10, 1924. Subject: Personnel activities.
On file, Historical Division, S. G. O.
(6) Report from Col. W. L. Keller, M. C., director of professional services, A. E. F., to the
chief surgeon, A. E. F., December 31, 1918. Subject: Brief outline of the organiza-
tion and activities of the professional services between April, 1918, and December 31,
1918. On file, Historical Division, S. G. O.
(7) Report from Col. J. F. Siler, M. C, director of laboratories and infectious diseases, to
the chief surgeon, A. E. F. (not dated). Subject: Activities of the division of lab-
oratories and infectious diseases, from August, 1917, to July, 1919. On file, Historical
Division, S. G. O.
(8) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lystcr, M. C, June 11, 1917.
Subject: Administration of American medical personnel serving with British Service.
On file. Record Room, S. G. O. (9795).
(9) Official report from the chief of the U. S. Army Ambulance Service with the French
Army, April 15, 1919, by Col. Percy M. Jones, M. C. On file, Historical Division,
s. g". O.
(10) Circulars, chief surgeon's office, A. E. F. No. 36, June 11, 1918; No. 38, July 11, 1918;
No. 45, August 13, 1918; No. 50, October 4, 1918; No. 54, November 9, 1918.
(11) Report of the Medical Department activities of Base Section No. 5, including Naval
Base Hospital No. 5, compiled under the direction of, and submitted by, the base
surgeon, to the chief surgeon, A. E. F. (undated). On file. Historical Division,
S. G. O.
(12) Weekly numerical reports of personnel of the Medical Department, A. E. F. On file,
Historical Division, S. G. O.
(13) Report of strength of the A. E. F., by months, as shown by the consolidated returns
for the American Expeditionary Forces. On file, Returns Section, Miscellaneous
Division, A. G. O., January 12, 1924.
(14) Report of Medical Department activities at Naval Base Hospital No. 1 (undated), by
the commanding officer. On file. Historical Division, S. G. O.
(15) Report of the Medical Department activities of the 2d Division (undated) by the divi-
sion surgeon. On file, Historical Division, S. G. O.
(16) Report on movement of surgical teams (undated) by the director of professional services,
A. E. F. On file, Historical Division, S. G. O.
(17) Wadhams, Sanford H., Col. M. C, and Tuttle, Arnold D., Col., M. C: Some of the
Early Activities of the Medical Department, A. E. F. The Militartj Surgeon,
Washington, 1919, xlv. No. 6, 636.
(18) War Diary, chief surgeon's office, A. E. F., January 11, 1919.
(19) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April 17,
1919. Subject: Medical Department activities, A. E. F., to November 11, 1918.
On file. Historical Division, S. G. O.
(20) War Diary, chief surgeon's office, November 20, 1918.
(21) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., March
20, 1918. Subject: Activities of chief surgeon's office. On file. Historical Division,
S. G. O.
(22) Embarkation Instructions, Headquarters, Services of Supply No. 1, November 20, 1918,
to and including No. 30, August 7, 1919. On file, A. G. O., World War Division,
321.1 (Embarkation Service).
104
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(23) Memorandum from Lieut. Col. E. M. Welles, jr., to Col. S. H. Wadluims, M. C,
deputy of chief surgeon with General Staff, December 9, 191S. Subject: Table
showing allowance of officers of all grades for A. E. F. on a basis of 1,500,()()() men.
On file, A. G. O., World War Division, chief surgeon's files (320.21).
(24) Letter from the chief surgeon, A. E. F., to Maj. James A. Shannon, Inf., chief of person-
nel. General Headquarters, August 4, 1918. Subject: Promotions. On file. Histori-
cal Division, S. G. O.
(25) General Orders No. 80, W. D., Washington, D. C, June 30, 1917.
(26) Statement based on a study of general correspondence concerning the Sanitary Corps.
On file. World War Division, A. G. O., chief surgeon's files (211.234).
(27) Cable No. 1178-S, par. 5, from General Pershing to Chief of Staff and Surgeon General
of the Army, May 25, 1918.
(28) Cable No. 377-S, par. 1, from the chief surgeon, A. E. F., to The Adjutant General,
U. S. Army, for the Surgeon General, October 30, 1918.
(29) Cable No. 252-R, par. 2, from the Surgeon General to the chief surgeon, A. E. F.,
November 8, 1918.
(30) Cable No. 1738-S, par. 1, subpar. D, from General Pershing to The Adjutant General
of the Army, October 3, 1918.
(31) Cable No. 1780-S, par. 1, subpar. C, from General Pershing to The Adjutant General
of the Army, October 11, 1918.
(32) Cable No. 2095-R, par. 1, from The Adjutant General of the Army to General Pershing,
October 23, 1918.
(33) Letter from the chief surgeon, A. E. F., to the commander in chief, April 19, 1919.
Subject: Promotions of officers in the Sanitary Corps, Medical Department. On
file, A. G. O., World War Division, chief surgeon's files (211.234).
(34) U. S. Compiled Statutes 1916 (act of February 2, 1901, C. 192, sec. 18), 31 Stat. 752.
(35) Memorandum from legal reference section to Capt. E. J. Berry, S. C, January 10,
1919. Subject: Contract surgeons. On file, A. G. O., World War Division, chief
surgeon's files (211.26).
(36) Contracts between the chief surgeon, A. E. F., and Dr. Paul Gallagher, October 9, 1918,
and Dr. H. B. Marville, August 1, 1918. On file, A. G. O., World War Division,
chief surgeon's files, the first contract under 201 (Gallagher), and the second con-
tract under 211.25 (Contract Surgeons).
(37) Letter from Dr. Esther C. Leonard, contract surgeon, to commanding officer, hospital
center at Vichy, December 5, 1918. Subject: Quarters; contract between the
commanding officer, hospital center at Vichy, and Dr. Anna Tjomsland, December
4, 1918. Both on file, A. G. O., World War Division, chief surgeon's files, 211.26.
Statement of service furnished to The Adjutant General, LT. S. Army, V^y the Surgeon
General, June 30, 1922. Subject: 9 contract surgeons (female) V. S. Army, who
served overseas. On file, Personnel Division, S. G. O.
CHAPTER VI
THE DENTAL SECTION
The dental subdivision of the chief surgeon's office, though part of the
personnel division/ was in a large degree separate therefrom.- Because of
its relationship with the personnel division, its activities are considered here,
though these were of a much wider character than control of dental personnel
alone. It exercised both general and technical control over all matters affect-
ing the dental service throughout the American Expeditionary Forces; e. g.,
dental laboratories, procurement and distribution of dental supplies, dental
organization, professional dental service, and liaison with the maxillofacial
services.^
In view of the fact that the dental service was not classed among the pro-
fessional services and, therefore, can not logically be discussed with them in
another part of this volume or in others, it appears expedient to consider here
not only the activities of the dental section of the chief surgeon's office, but of
the administrative activities of that service as a whole.
On June 12, 1917, General Pershing cabled through the American ambas-
sador, London, to the Secretary of War, requesting that the senior dental
officer of the Army be sent to France with the second convoy of troops, there
to establish a depot and organize work, and that dental officers be sent with
all troops in proper proportion.^ Confidential orders were issued by the War
Department, June 25, 1917, in compliance with the above request.* During
a conference with the Surgeon General of the Army, prior to embarking, the
dental officer in question made request for authority to organize and take with
him a dental corps unit, to be composed, with himself, of six specially qualified
dental surgeons.^ This request was granted, the necessary telegraphic orders
were issued, and the members of this unit assembled in New York City, July
10-15.^ Regulation field equipment and supplies, with which the five officers,
other than the chief of this group were supplied, were augmented through
purchase of complete laboratory equipment and supplies, and special oral
surgical instruments and appliances.^ Transportation was secured with the
second convoy, due to sail on or about July 28.-'
During the latter part of June the Surgeon General had also requested
orders directing 20 members of the newly organized Dental Service Corps to
proceed to New York for transportation with the second convoy of troops. -
Several members of this corps, attached to Base Hospitals Nos. 8 and 9 and
to the First Regiment of Engineers, were at this time also assembled at the port
of embarkation, and a total of approximately^ 30 dental officers were provided
transportation with the second convoy.^ Unfortunately, all the equipment and
supplies of the First Army Dental Corps Unit was submerged in the sinking
of the vessel on which its members were embarked, and though a large por-
tion of the equipment and supplies was rescued several weeks later, it proved
worthless and a total loss.^ The unit was reequipped by the local medical
supply depot and finally sailed early in August, 1917.^
105
106
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Upon arrival in France, all the dental officers destined lor organizations
of the 1st Division proceeded to the division training area to join their com-
mands; those attached to base hospitals accompanied these organizations to
their station, and all personnel of the First Dental Corps Unit proceeded in
accordance with their orders to headquarters, A. E. F., then in Paris, where,
on August 22, 1917, the head of this group reported to headquarters. ^ He was
then directed to report to the chief surgeon for duty as assistant in matters
pertaining to the dental branch/
Plans for the organization of the Medical Department, A. E. F., already
under way, contemplated the utilization of dental personnel in several newly
created administrative positions. At a conference in the chief surgeon's office,
it was decided that the First Dental Corps Unit should be broken up and its
personnel assigned to stations where technical administration and supervision
would be required.^ Its members were then individually assigned to the
office of the chief surgeon; headquarters, Field Artillery brigade, Le Valdahon;
headquarters, 1st Division, Gondrecourt; Medical Supply Depot, Cosne; head-
quarters, field hospital company, 1st Division, Gondrecourt training area; and
to the dental clinic at headquarters, A. E. F.^
Throughout the war, the dental section continued to function as a part of
the personnel division in the chief surgeon's office, moving with it to Chaumont
on September 1, 1917, and later to Tours in March, 1918.^
When headquarters, A. E. F., were moved to Chaumont, a headquarters
dental clinic was established there. ^ Here two complete field outfits and a
laboratory were installed under direction of the senior dental surgeon, and
began operating within 48 hours after the establishment of headquarters. This
establishment continued its activities until the last day those headquarters
remained at Chaumont.^
During September and October, 1917, plans were formulated and their
application inaugurated for an organization which would direct and control
the dental service of the great number of troops expected.^ Consideration was
given to providing administrative positions whose occupants w^ould supervise
the professional and official service of dental officers on duty with major com-
mands; to the assignment of specially selected dental officers to supply depots
and service schools, and to provision of professional consultants of chief clini-
cians at important hospitals and of oro-dental specialists qualified for service
at maxillofacial hospitals.^ The organization of the office of the senior dental
surgeon was completed and plans were made for the instruction of all dental
officers holding administrative positions.^ Instruction was given to a large
degree by means of correspondence between the chief of the dental section
and his subordinates. This was supplemented by his frequent inspections at
the several divisions and hospitals within the training areas. Instruction of
di vision dental surgeons began with the establishment of a school for them in
the 1st Division on September 15.^
On October 12, 1917, a cablegram was received from the Surgeon General's
office, announcing that the Army Dental Corps reorganization bill had been
signed by the President on October 6, 1917.^ Office orders were then issued
assigning the senior dental surgeon to duty as chief dental surgeon, under general
ORGAXIZATIOX AND ADMIXISTEATIOX OF CHIEF SURGEON'S OFFICE 107
direction of the chief surgeon, A. E. F., and on October 27 his duties became
wholly those of an administrator and director of the de-ntal service, A. E. F.^
Though technically belonging to the personnel division of the chief surgeon's
office, he was provided a separate office and clerks. During October and Novem-
ber, further consideration was given to the preparation of adequate plans for the
organization of the Dental Corps on the comprehensive lines necessary to meet
the need of an army of 1,000,000 men.^
Shortly after the arrival of the chief surgeon's office at Tours, in March,
1918, the office personnel of the dental section was increased by 2 sergeants,
Medical Department, for the record room and 1 additional enlisted stenographic
clerk.^ Thereafter from time to time the division expanded to meet the
requirements of increased service until, in addition to the commissioned per-
sonnel, it had a maximum of 4 stenographers and 9 record clerks.^
Until June, 1918, the only officer serving in the dental section was the chief
dental surgeon; another officer charged with procurement and distribution of
dental supplies was then assigned, and in September, 1918, this personnel was
reenforced by a third officer.^
ORGANIZATION OF THE DENTAL SERVICE
Though the organization which the Dental Corps finally developed was
begun early in the history of the American Expeditionary Forces, its completion
in a satisfactory manner was not practicable until after the bill reorganizing
the corps became a law on October 6, 1917.- By this organization, each
division was allowed 30 dental officers, under direction of a senior, the
division dental surgeon.^ The latter was under the general direction of the
division surgeon and was charged with the responsibility of coordinating,
supervising, directing, and inspecting the dental service of the division.^ The
senior dental officer with regiments which required more than one dental surgeon
was designated regimental dental surgeon and charged with the responsibility of
conducting the service of his specialty. When army corps were organized it
became necessary to appoint corps dental surgeons, who were under general
directions of the corps surgeon. These administrative officers were charged with
the coordination and direction of all the dental service of their respective army
corps, which included the inspection, supervision, and instruction of the several
division dental surgeons, and supervision and control of all dental officers
assigned to duty with corps troops.^ After the organization of field armies,
experienced dental officers were assigned to duty as army dental surgeons, under
general direction of the army surgeons and were charged with the responsibility
of supervising and coordinating the dental service in the respective commands in
which they served, including the dental service of divisions, corps, army troops,
evacuation, and mobile hospitals. Their administrative activities pertained
chiefly to the service of dental surgeons of corps and divisions. Those officers
rendered reports to them through medical department channels and their own
reports and returns were made in turn, through medical department channels to
the chief surgeon, A. E. F.^ In the Services of Supply a supervising dental
surgeon in charge of the service of his specialty in each section (including the
district of Paris) was vested with the responsibility of coordinating and con-
108
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
ducting the service' under general direction of the surgeon. He also submitted
reports and returns, through medical channels, to the chief surgeon. Hos-
pitals centers, depot divisions, replacement depots and later, embarkation
areas were provided with local dental supervisors, usually selected from among
the senior dental officers of those commands.- Their duties, in addition to
those of a professional character, were the centralization and coordination of the
professional service and supply of the dental department in their respective
jurisdictions under general direction of the senior medical officer through whom
their reports and returns were rendered to the chief surgeon.^ In all of these
organizations large dental infirmaries were established in favorable locations
where a number of dental surgeons were assigned under centralized control.^
Each hospital in the American Expeditionary Forces was staffed and equipped
for dental service.^ Base and evacuating hospitals usually had two dental
officers equipped with complete base outfits and laboratories; all other hos-
pitals had at least one dental officer equipped with operating outfit only.^
In the early fall of 1917, the French turned over the artillery training
area at Mailly to the American forces for the development of Coast Artillery
organizations.^ As the dental officers who accompanied the first American
organizations moving into this area were all recently appointed from civil life,
it was necessary to send an experienced officer to organize and coordinate their
services. This he accomplished partly through the establishment of a small
school of instruction.^
The general plans for the organization of the dental service, A. E. F.,
were made and tentatively approved early in its history. The approval,
however, had the provision that none of them would be put into effect until
called for in the general scheme for the organization of higher commands.^
Such organization, however, was immediately initiated for the units of the
expedition then present and the 1st Division being well advanced in its combat
training, was the first to receive the benefits accruing from this development.^
Among other provisions, orders were issued announcing a division dental
surgeon and providing for dental inspection, technical supervision, a head-
quarters dental clinic, and schools.^ When in the early fall of 1917, the 2d
Division moved into its training area with headquarters at Bourmont, dental
officers were assigned to its several imits.^ No division dental surgeon had
been sent over with it, but one was designated from the American Expedi-
tionary Forces in the latter part of November. Under his direction the dental
service of this division was organized, a division school established and the other
activities were thoroughly coordinated. Like action was taken for the 26th
and 42d Divisions.^
An important development within each combat division area was the
establishment of a headquarters dental clinic.^ Each of these clinics was
served by competent operators and was fully equipped, including complete
laboratories; each was technically in charge of the division dental surgeon
who was responsible for its efficient management. Later, w^hen divisions
entered upon the last phase of combat training, instructions were issued for
organization within each division of a portable dental laboratory.^ This unit
was placed in charge of a selected dental officer conversant with dental labora-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 109
tory practice, who was assisted by a specially qualified dental mechanic. This
laboratory, which assumed the necessary prosthetic service for the division
and obviated need of transferring patients to points outside its command,
usually was located at the division field hospital, which was farthest from the
line. After our divisions assumed combat activities, this unit assisted in first
aid at the front. ^
When the line of communications was organized in August, 1917, with
headquarters in Paris, all dental surgeons except those attached to divisions,
detached combat organizations, or to base hospitals, came under control of
the line of communications and were assigned by its headquarters to duty
with detached commands in its several sections.^ A headquarters dental
clinic was organized in the headquarters of the line of communications, its
first equipment consisting of the old type portable dental outfit, with which
all dental officers arriving from America were supplied. This equipment
was augmented by complete base dental outfits for two operators and one
complete laboratory.^
After removal of headquarters, line of communications, to Tours, in
June, 1918, this clinic, remaining in Paris, became known as the attending
dental surgeon's office, district of Paris. ^ It was increased in size by the
assignment of additional dental officers with full base equipment to meet the
growing requirements of its service, and continued to function until with-
drawal of the American Forces in France from the district of Paris toward
the end of 1919.^
When the advance section w^as organized in the latter part of February,
1918, a supervising dental surgeon was assigned to it, and the office of the
chief dental surgeon thereby relieved to an appreciable extent.^ This super-
vising dental surgeon was charged with the supervision and coordination of
all elements of the dental service throughout his jurisdiction. The majority of
troops then in the area were widely scattered; e. g., engineer organizations
making preparation at a number of camps for the early arrival of large numbers
of American troops, and signal corps battalions installing telegraph and tele-
phone lines. ^ Many other detached organizations were later located through-
out this section.^ The dental officers attached to these several commands
were all under the technical direction and instruction of the supervising dental
surgeon, advance section.^
Approximately 35 dental officers were serving within the advance section
at the time of its organization. This number w^as more than doubled there-
after until November, 1918. But their number remained short of that required
and it became necessary to assign several of them to an itinerant service
in order that they might visit some of the smaller units. ^
The intermediate section. Services of Supply, with headquarters at Nevers,
was in operation for some time without organized dental service, but increase
of the various activities throughout its area and the arrival of dental officers,
newly appointed from civil life and unacquainted w^th military procedure,
necessitated the appointment in April, 1918, of a section dental surgeon.^
The duties of this officer w^ere similar in every respect to those outlined above
for the supervising dental surgeon, advance section.^
110
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The wide dispersion of troops in the intermediate section also presented
many difficulties in the furnishing dental service; furthermore, some organi-
zations were much expanded after arrival in France; e. g., an engineer regiment
which landed with approximately 2,000 men had expanded before the end
of activities to a strength of 20,000.^ Since the legal allowance of dental
officers for the American Expeditionary Forces was based on the proportion
of one dental officer to every 1,000 men, and as units were organized when
they sailed, it was not practicable to supply dental officers in a corresponding
degree to those units which were expanded overseas.^
The organization of the dental service for base sections began with the
appointment of a supervising dental surgeon for base sections Nos. 1, 2, and 5
in April, 1918.^ Owing to the shortage of experienced dental officers of field
grade, it was necessary to utilize one officer to organize the dental service
for the three sections. While it was appreciated that it would be difficult
for one officer to exercise dental supervision of three important base sections,
this arrangement was maintained for several months.^ In December, 1918,
a supervising dental surgeon was appointed for base section No. 1 (St. Nazaire)
and in the same month another for base section No. 2 (Bordeaux) This
position in base section No. 5 was at first filled by a temporary assignment
but later a permanent detail was made. The supervising dental surgeon
of a base section discharged duties similar to those mentioned above in con-
nection with the advance section, but he also exercised technical supervision
over the receipt and storage of dental supplies arriving at the port and organ-
ized and developed dental clinics at section headquarters and at the disem-
barkation camps where troops were held temporarily.^
No supervising dental surgeon was designated for base section No. 3,
for the surgeon of that section considered such an assignment unnecessary.^
Base section No. 4 having comparatively few American organizations
or activities, was therefore never provided with a supervising dental surgeon.
The dental service of the permanent command and of detached organizations
there was supplied by dental officers assigned to organizations temporarily
within the section.^ A supervising dental surgeon for base section No. 6
was not appointed until December, 1918.^
The dental service in the large areas occupied by depot divisions had to
be expanded in order that adequate clinics might be established in the several
billeting towns and camps. In the First and Second Depot Division areas this
was effected by the division dental surgeons, each of whom also organized and
equipped a central dental clinic and dental laboratory.^ The establishment
provided at St. Aignan (First Depot Division) proved a model for this type of
clinic, being the first organized for group dentistry. Later, in order to meet
local requirements, a course of instruction was carried on in the first depot
division area in order to develop dental assistants from selected young men
serving in medical detachments of the division concerned.^
At the five replacement depots, located, respectively, near Amiens (with
the American Second Corps), to the northwest of Paris, adjacent to St. Dizier,
adjacent to Toul, and near the town of Meaux, the dental service was similar
in every respect to that of the First Depot Division.^ It comprised the organi-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 111
zation of large dental clinics where the mouths and teeth of soldiers passing
through the depot might be placed in first-class condition without appreciable
loss of time. These clinics gave full opportunity for group dentistry and proved
of the greatest value as time-saving expedients.^
PERSONNEL
The total number of officers who served in the Dental Corps, A. E. F., was
1,876.^ The highest officer strength of that corps was 1,805, which it attained
on January 11, 1919.^ Of these officers 79 belonged to the Dental Corps,
United States Army, 12 to the Dental Corps, United States Navy, about 225
to the National Guard, and the others to the Dental Reserve Corps. ^
The total personnel, including enlisted men of the Medical Department
assigned to its service, approximated 4,000, of whom more than 2,000 (includ-
ing the officers above mentioned) were graduate dentists.** The enlisted men,
Medical Department, assigned for duty to the Dental Corps served either as
dental assistants or as dental mechanics. Many of them were undergraduates
in dentistry.*
The full quota of commissioned dental personnel authorized at the rate of
1 to 1,000 men was never attained in the American Expeditionary Forces, and
there was a shortage of over 300 dental officers at the time the armistice was
signed.* A dental officer was sent with approximately every thousand men of
large organizations embarking from the United States, but this ratio was not
extended to small organizations and to casuals, so that a shortage accrued for
the American Expeditionary Forces as a whole.* This shortage was most
apparent in organizations that greatly expanded overseas, as noted above.
Furthermore, it was found necessary to give three dental officers to each combat
division in excess of the pro rata allowance, because of the fact that certain units;
e. g., field signal battalions, machine-gun battalions, with less than 1,000 men
each, operated as separate organizations.* But after the armistice began a
general plan for equalization was carried out whereby each command was
assured of dental service. The full quota eventually was reached by reassign-
ment of about two-thirds of the dental personnel from each division sent
home, for only a skeletonized dental force was authorized to return with the
division which it had served.* That contingent remained with the division for
the purpose of rendering professional services during the voyage. This practice
of retaining part of the divisional personnel was discontinued in April, 1919.*
Though the great majority of dental officers came from the United States,
either with troops or as casuals, several American dentists, among other patri-
otic citizens already in Europe, offered their services shortly after American
headquarters were established in France.^ It was announced that the policy
of the Medical Department would be to accept the services of all physicians
and dentists, subject to a professional examination which would determine
that they were professionally qualified.^ Five approved civilian candidates
were eventually commissioned in the Dental Corps after examinations and a
considerable number of enlisted men were also examined for temporary com-
missions in the Dental Corps. ^ A total of 123 passed their examinations in
13901—27 8
112
ADMTXISTRATIOX, AIMERICAN EXPEDITIONARY FORCES
France, but onk 40 of these were enabled to serve as officers on account of a
War Department decision not to commission after the armistice began candi-
dates who passed the examination.^ Recommendations were made to the
adjutant general, A. E. F., that the 83 successful candidates who had not been
commissioned at the time of the signing of the armistice be appointed and
commissioned in the grade of first lieutenant. Dental Reserve Corps (inactive
status), and that their commissions be given them as a reward of merit on the
date of their final discharge from the Army.^ This recommendation was
approved and was largely carried out. In many instances, however, the
commissions were not forthcoming until several months after discharge.^ The
regular Dental Corps was increased by nine officers through appointments
made in the American Expeditionary Forces from the Dental Reserve Corps.^
While the majority of dental officers of the American Expeditionary
Forces served in France, a large number arriving with organizations in Eng-
land were detained there temporarily or permanently for duty at our several
hospitals, aviation camps, and instruction centers.^ Several dental officers
were detailed for duty w^ith organizations serving in Italy and northern Russia,
and in March, 1919, 20 dental officers, with enlisted assistants and full portable
outfits, were sent to the United States military mission, Berlin, Germany, for
special duty in the Russian military prison camps. ^
During the fall of 1917 it was announced that the six American base
hospitals then loaned to the British would eventually come under control of
the American Expeditionary Forces, but this was never actually accomplished.^
Nevertheless, a number of medical and dental officers belonging to these units
were detached and assigned to service in the American Expeditionary Forces.
Thirteen dental officers were obtained in this manner.^
SCHOOLS
Division schools for the instruction of recently joined and inexperienced
dental reserve officers were established in the early fall of 1917.^ It was
recognized that these officers, however well qualified professionally, were
unacquainted with methods of conducting a military dental practice, with
customs of the service, the system of obtaining supplies, military correspond-
ence, and the formulation of reports and returns.^ The instruction, there-
fore, considered the methods of conducting a military dental practice, duties
of an officer, customs of the service, procurement of supplies and equipment,
preparation of reports and records. The division dental schools were in charge
of the division dental surgeons and under general direction of the division
surgeon concerned.^ Sessions were held two afternoons a w^eek. The advan-
tages of this instruction were soon apparent in the dental service of the 1st
Division, in which the first school of this character was established, and which
became the model for the dental section of the Army sanitary school. Similar
schools were conducted in all the other early divisions in France.^
The plan for division instruction w^as changed in November, 1917, by the
organization of the dental section of the Army sanitary school at Langres.^
With a full realization that a large number of specially qualified officers,
both medical and dental, would be needed for face and jaw surgery, immediately
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 113
upon entry of the American Army into combat activities, preparations were
made to establish a post-graduate course of instructions in oral, plastic and
prosthetic surgery.^ This was conducted at the American Red Cross Military
Hospital No. 1, Neuilly, which was selected for this purpose because of its
central location and the excellence of the facilities which had long been estab-
lished there. ^ A competent faculty of well-qualified and experienced instruc-
tors was assembled at this hospital, under the direction of a colonel of the
Medical Corps. ^ The several subjects of the curriculum were as follows:
Special anatomy, bacteriology and infections, face and jaw fractures, plastic
surgery, oral surgery, prosthetic surgery (fracture appliances), postoperative
care. Roentgenology and photography, anesthesia, and Medical Department
administration in war.^
A schedule for lectures and clinical instruction was prepared and it was
planned that the school would open in January, 1918, but this was deferred
until March. ^ Owing to the enemy offensive, which started March 21 and the
necessity for using in large degree as evacuation hospitals all hospitals in the
Paris district, this important course was indefinitely postponed.^ It was finally
abandoned on account of the continuous battle activities immediately north of
Paris and because of the arrival in March, 1918, of 40 medical and dental
officers, specially trained in maxillofacial surgery. The availability of these
officers, obviated any need for the school. They were organized with teams
and distributed as described below.^
A school for the instruction of enlisted men as dental assistants was early
organized at headquarters, First Depot Division, St. Aignan.^ Through dili-
gent investigations conducted in the several units of the 41st Division, now
designated First Depot Division, and of the several casual groups arriving from
the United States as replacement troups, several hundred young soldiers were
found and brought to this school for instruction as dental assistants. A large
percentage were undergraduates in dentistry who in consequence readily took
up this special work. They were given an intensive course of instruction and
upon its completion were awarded certificates of proficiency. A list of each
class was sent to the chief surgeon, A. E. F. who made assignments from it
throughout the dental service.^
In order to meet the demands for competent laboratory assistants —
dental mechanics — a school was organized at the central dental laboratory head-
quarters. First Depot Division, in extension of the course for dental assistants.^
The men sent here were given intensive instructions in primary laboratory
work for a period of one month. Upon its completion they were classified
and those rated as most proficient were sent to a second school for dental
mechanics, which was established in the dental laboratory at American Red Cross
Military Hospital No. 1, Neuilly.- Here they were given advance instruction
in dental and oral surgical prosthesis, which comprehended the construction
of swaged and cast-metal splints and all other fractured jaw appliances required
in maxillofacial surgery. Upon completion of a six-week course of instruction,
the graduates were given certificates and assigned to duty at the various base
hospitals where this special type of surgery was being conducted.^
114
ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
After the armistice began a school for instruction of dental assistants in
oral hygiene and prophylaxis was organized at headquarters, Base ISection No.
2, Bordeaux. It admitted students selected from among 400 enlisted men and
gave them instruction on a number of subjects pertaining to the practice of
dentistry. On graduation these men were assigned to service at the larger
clinics.^
In February, 1919, the American University was established at Beaune.^
Its dental department began work on March 12, 1919, being the first depart-
ment to open.^
During the autumn of 1918 a special course of clinical instruction was
conducted in dental and maxillofacial prosthesis by the senior consultant in
prosthetic dentistry. This officer visited each hospital center and important
base hospital and then gave instruction to officers and dental mechanics in the
highly specialized technique of maxillofacial prosthesis. -
SUPPLIES AND EQUIPMENT
Originally the types of dental equipment for the American Expeditionary
Forces w^ere those prescribed by the Surgeon General, viz, portable dental out-
fits for dental officers attached to field organizations, and the base dental equip-
ment (as far as practicable) for all base hospitals.*
The plans promulgated by the headquarters, A. E. F., in the summer of
1917, for the shipment of all Army supplies provided for a reserve of approxi-
mately four months, but requisitions issued by the Medical Department for
the shipment of supplies for the 1st Division included approximately a five
months reserve.* Its subsequent instructions in regard to the 2d, 26th, 42d, and
41st Divisions contemplated but a four months reserve and thereafter until the
inauguration of the automatic supply table, excess supplies were issued on the
basis of three months reserve. The plan contemplated the storage of 15 days
supply at the advance depots, 30 days supply at the intermediate depots, and
45 days supply at base sections. While this plan was never completely followed,
it proved of value as it assured storage in France of a reserve supply. The
plan was materially changed after the adoption of the automatic supply system
which became effective in March, 1918.^
The Medical Department automatic supply table %vas prepared after due
consideration and elaborate study based on plans outlined by the general staff
in the summer of 1917. Six months experience and observation were utilized in
its formulation and preparation. The dental department participated in its
preparation in so far as its own supplies w^ere concerned.^
The dental tables of the automatic supply were formulated to meet actual
requirements of portable dental outfits for the 30 dental officers authorized for
each combat division, for the outfits of the various detached commands in the
Services of Supply, and for normal replacement of these assignments.^ The cal-
culations for base dental outfits were made upon the requirements of hospitals
which pertained to divisions and of those that were to be stationed in the Services
of Supply plus the normal replacement for equipment of this character.^ The |
arrival of certain kinds of dental equipment and supplies was delayed by the
priority shipment of other articles — rations, clothing, ammunition, etc. — bv con-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 115
gestion at the ports of embarkation and debarkation, by lack of adequate facili-
ties at the base ports for systematic storage and by lack of facilities for prompt
movement by rail to place of destination.^ Because of this delay it was neces-
sary to make some emergency purchases of dental equipment and supply in
France, through the medical member of the general purchasing board in Paris. ^
With a view of facilitating these special purchases, a dental officer was assigned
temporarily to duty with that board. Until the automatic supply became
effective and continuous the purchase of certain articles of dental equipment
was conducted on so great a scale as seriously to embarrass the French market.^
The French authorities soon observed this situation and placed an embargo on
the further purchase of dental supplies by the American Army, but upon our
protest to this inhibition the embargo was raised for a few weeks and further
purchases were authorized to the value of 1,000 francs per month. ^ The
demands for laboratory equipment were so great and the supply so limited in
France that it was necessary to investigate the possibilities of purchasing this
type of equipment in England.^ The supply officer for the Medical Department
who was ordered to London for this purpose succeeded in purchasing laboratory
equipment and supplies in amounts considered sufficient to last until material
of this type was received from the United States, through operation of the auto-
matic supply table. ^ The British War Office, on observing the depletion of
this type of special material, also placed an embargo on further purchases of it
by the American Army. None of this much-needed laboratory equipment which
had been purchased by the medical supply officer in England ever reached France,
for the British vessel on which it was shipped was sunk by enemy submarines.^
The original plans for shipment of dental equipment contemplated that each
dental officer embarking with his organization for overseas duty take with him
a complete portable outfit, whose several chests were filled with six months' sup-
ply.^ Theoretically this arrangement was eminently satisfactory, and proved
to be so in the early months of the war before the overseas transportation became
congested. Later, dental equipment was placed aboard ship with all the other
elements of the cargo which were unloaded en masse at the base ports in France.
Here the dental equipments were lost in the overcrowded warehouses or at the
large supply dumps adjacent thereto.^
In the effort to remedy this situation, a cablegram was sent to the Surgeon
General recommending that previous instructions on this matter be so modified
as to direct each dental officer to carry his portable outfit as baggage, for which
he would be personally responsible both on shipboard and after arrival in
France.^ This plan was carried out more or less satisfactorily and was insisted
upon as the only possible method that would insure the dental officer having his
equipment in his possession on arrival.^ But in maintaining this plan the dental
service ran counter to that general instruction to port commanders which directed
that equipment be unloaded from ships and placed in a pool, to be subsequently
claimed if possible, and if not, replaced through emergency requisition on
supply depots.-'
In accordance with previously arranged plans of organization, competent
dental officers were assigned to duty at the impotrant supply depots, the first
officers thus assigned reporting at the depot at Cosnes on September 1, 1917.^
116
ADMIXI8TRATIOX, AMERICAN FA'PEDITIONARY FORCES
His duties woro later extended to ineliide purchase of dental equipment and
supplies through the medical member, general purchasing board. On March 1,
1918, a dental officer was assigned to the advanced medical supply depot,
Is-sur-Tille.^ On account of the great amount of dental supplies received at
medical supply depot No. 1, base section No. 1, in the earlier months of 1918,
a dental officer was placed there on duty as assistant to the medical supply
officer, where he remained until June, 1919.^ In 1918 one or two more dental
officers were detailed to serve with the other large supply depots. These officers
remained for short periods on temporary duty.^ In the late autumn of 1918 a
dental officer was sent to the Gievres depot for temporary duty to develop
certain articles of field equipment.^ No dental officers were permanently
assigned to supply duty at the base ports other than at St. Nazaire (base section
No. 1), but the supervising dental surgeons in the base sections were available
to render counsel concerning dental equipment.^
Actual field experience in combat divisions early demonstrated the fact that
the old pre-war portable dental outfits were not practicable for active field service.
The bulk and weight of the several containers seriously handicapped their trans-
portation with mobile units. After careful study the following conclusions were
reached concerning the field dental equipment:^ The full portable outfits were
to be retained for use at camp hospitals and at such other detached organizations
of the Services of Supply as could readily furnish transportation for them.
Modified portable outfits packed in three chests were provided for combat
divisions.^ These consisted of the essential equipment of medicines and of a
small stock of supplies Which were considered sufficient for the practice of field
dentistry.^
An even more reduced outfit, termed "campaign equipment," was provided
for the use of dental officers with divisions in battle areas. ^ This consisted of a
•dental engine chest and its normal contents, plus the contents of the emergency
dental kit. This kit was designated personal dental equipment and was to be
carried by each officer at all times while in the combat area. It comprised a few
essential instruments and medicines in cloth rolls and a very small amount of
supplies, all contained in Hospital Corps pouches carried over the shoulder by the
dental officers and their assistants.^ Thus officers were enabled to render first-
aid dentistry at all times for the relief of pain and for minor oral surgical or dental
operations. This modification of dental equipment helped solve many of the
transportation problems for the dental service in combat divisions, and while it
increased the weight carried by dental officers, it proved advantageous by
making it possible for anyone requiring emergency dental service to obtain it at
any time from the dental officer of his command.^
In combat divisions, the transportation of dental equipment and supphes
was always a problem and when not carried individually, a source of irritation
to division commanders, transportation officers, and division surgeons.^ This
was largely due to the fact that no provisions had ever been made in the Tables
of Organization for dental personnel, commissioned and enlisted, or for dental
equipment. Omission in these tables of the Dental Corps and of provision
for transport of its supplies resulted in the loss of much equipment and the
consequent temporary lack of dental service in several of the divisions.^ The
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 117
1st Division on its movement into a combat area in May, 1918, to mid it
expedient to abandon all its dental equipment on account of the lack of trans-
portation, for this material had not been considered by its transportation
oflicer in making his allowances for the rapid movement of equipment and
supplies.^ This loss was immediately investigated and efforts were made for
finding and salvaging the abandoned equipment. Though not found at the
time it was subsequently redeemed through the salvage service.^ In the
interim, through efforts made at intermediate medical supply depot No. 3, the
dental service of the division was reequipped with modified portable outfits.
As a result of the information obtained by the chief dental surgeon, who was
sent to investigate the matter, the dental service, both personnel and equip-
ment, was for the first time provided for in division tables of organization.^
Instructions on the subject were published in General Orders, No. 99, G. H. Q.,
A. E. F., June 19, 1918, which provided for a divisional dental service com-
prising 31 officers and 32 enlisted men, with 10 portable dental outfits, 20
modified portable outfits and 1 portable laboratory. The total weight of this
equipment was 12,000 pounds and its bulk 574 cubic feet.^
A portable dental laboratory was also adopted to meet the prosthetic
requirements of a division.^ All essential equipment for this was packed in
one dental supply chest, which weighed approximately 200 pounds.
When the several army corps were organized provision was made for
supply parks at or near the headquarters of each, except for the Second Army
Corps, which was operating under the British.^ In accordance with the Abbe-
ville agreement replacement supplies were to be furnished by the British Army
for the troops composing divisions of that corps. Therefore, the American Expe-
ditionary Forces were not directly concerned in its replacement supplies until
the late fall of 1918, when the corps reverted to American control.^ The initial
dental equipment and supply for the troops in that corps would have been
amply sufficient to carry them through their campaign under British control,
had it not been that all their equipment was reduced to a minimum and excess
supphes abandoned immediately prior to their entry into the combat zone.
Each division was directed to organize supply dumps in its area for replace-
ment purposes.^ The corps parks and division dumps were fed from the
advanced medical supply depot, Is-sur-Tille, as were also the army supply
depots at the time of the organization of the First Armj^, August 12, 1918.^
Great difficulty was experienced in procuring the necessary special equip-
ment for maxillofacial surgery and for the prosthetic and reconstruction pro-
cedures required in the practice of that specialty.^ Adequate consideration
and study had been given this subject prior to the departure from the United
States of specialists in this line, and provision had been made whereby special
ciiests containing maxifiofacial unit equipment would be shipped immediately
on their departure.^ These plans failed and the much needed special equip-
ment for this service was not received until after the signing of the armistice.
It was found subsequently in the midst of a quantity of supplies at the port of
Marseille.- Loss of this equipment necessitated the purchase of all articles
of this type that could be found in France and the manufacture of such parts
of it as were not found in that market.- The British and French afforded the
118
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
benefit of their experience in the treatment of face and jaw wounds and this
greatly appreciated assistance helped materially in procuring much of this
special equipment through purchase and manufacture.^ Though this ocjuip-
ment was not available on many occasions when it was needed by the dental
officers at evacuation hospitals, mobile hospitals and at some few base hospi-
tals, the deficiency was well met by individual ingenuity and by improvisation.^
Generally speaking, the system of dental supply through operation of the
automatic table was satisfactory, this being especially true in regard to field
equipment.^ Theoretically, the automatic table met the situation in an admir-
able manner, and had ocean, rail, and storage facilities permitted its movement
according to the priority schedule, no shortage or delayed replacement or
replenishment would have occurred.^ As it actually worked out, the lack of
laboratory equipment and supplies was embarrassing on several occasions and
there was a long period extending over several months when the shipment of
greatly needed base outfits, including electrical equipment, was withheld.^
Consequently projects for installation of this type of equipment in all base
hospitals and major clinics were delayed. A large consignment of this class of
equipment and supplies arrived in November, 1918, and was thus available
for the several hospitals and the many large clinics then being established in
base sections, embarkation camps and army areas. ^ In these places efforts were
being made to render complete dental service for the troops who had been
temporarily deprived of it, through the exigencies of an active campaign.^
The following special appliances were developed in the American Expedi-
tionary Forces to meet the requirements of its dental service •}
AMEX DENTURE
A denture cast in aluminum of one piece, wherein the base plate and the
teeth themselves were reproduced in this light, inexpensive metal. This proc-
ess of plate construction lent itself admirably to the military service, inas-
much as more than 98 per cent of the dentures required were for partial loss
of teeth. For full dentures, well-matched porcelain incisors and cuspids were
attached thereto solely for esthetic purposes. These appliances materially
reduced the expense of dentures, the supply stock, and necessary equipment.^
AMEX CASQUE
A surgical appliance for face and jaw reconstruction; the further develop-
ment of a similar article used in the surgical services of the British and French
Armies. It consisted of an adjustable steel band, fitting around the circumfer-
ence of the head, with adjustable cranial bands and an adjustable perpendic-
ular rod and horizontal face bow. Its use in facial and jaw reconstruction
permitted of absolute fixation for either soft parts or osseous fragments, and
it was of great value in this class of highly specialized surgery.^
EMERGENCY KITS
These consisted of two Hospital Corps pouches to be slung from the shoul-
der, one for the dental officer and one for his enlisted assistant.^ They con-
tained the essential instruments and medicines, secured in cloth rolls, and sup-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 119
plies for administering first-aid dentistry and for the simpler operations of field
dentistry. They were prescribed articles of personal equipment for dental
officers and were ordered carried whenever combat organizations entered the
combat area. Through them it became possible for the troops to receive
emergency dental treatment for the relief of pain without leaving their com-
mands.^
FOLDING TRENCH CHAIR
This article of equipment was developed for the purpose of supplying a
seat, with stabilized head rest, in order that dental services might be rendered
conveniently in trenches, dugouts, and advanced dressing stations.^ It was
made of aluminum, reinforced by steel rods and was capable of being folded
and carried in a musette bag with the two pouches of the emergency kit. It
weighed, complete 4^ pounds.^
DENTAL AMBULANCES
The difficulties of supplying dental care to troops at outlying stations
emphasized the great need for dental ambulances, which when fully equipped
as ''mobile dental clinics" would be capable of traveling under their own power
from station to station.^ Plans were made to have such mobile dental clinics;
further, it was planned that they would remain at each station a sufficient
number of days to permit of the emergency dental treatment of the command.
Eleven such vehicles voluntarily contributed in America, and only requiring
transportation overseas, unfortunately remained at a home port of embarka-
tion for many months through lack of shipping facilities. Several communi-
cations urging their transportation were made by cable and letter to the United
States, but these were fruitless.^
Two dental ambulances were, however, presented in France to the dental
service, A. E. F.^ One, donated conjointly by two American dentists, had come
originally from American Red Cross hospital at Neuilly. It was thoroughly
overhauled, equipped, and put in charge of a dental officer November 1, 1917,
being designated dental ambulance No. 1, A. E. F.^ Assigned to the motor
transport division, Mailly, then located back of the line to the southeast of
Soissons, this vehicle continued to operate during the entire period of activi-
ties, its station assignment being with one or another of the several units of
the motor transport corps in the vicinity of Mailly. The second ambulance
was presented to the dental service by the American Red Cross, through its
medical director in Paris. ^ This ambulance was delivered at headquarters,
Chaumont, about March 1, 1918, and was immediately placed in charge of a
dental officer and designated dental ambulance No. 2.^ Its station assign-
ment was with the Air Service of the advance section, with headquarters near
Colombe la Belle, and its first location at the second bombardment airdrome.^
Throughout the entire subsequent period of activities this vehicle rendered
service to the several small detached stations adjacent to the headquarters,
Air Service.^
INSPECTION
It was early realized that the best service could be obtained only through
providing direct supervision and inspection of dental work by qualified dental
inspectors.^ Instructions therefore were issued requiring that each dental sur-
120
ADMIXISTRATIOX, AMERICAN EXPf:i)ITU)NAH V FORCES
gcoii in an administrative position make regular and systematic inspections of the
dental officers attached to the command.- These inspections were to consider
personnel, both commissioned and enlisted, discipline and efficiency, character of
service, etc. Reports of inspections were forwarded through medical channels
to the office of the chief surgeon, A. E. F, In addition to these inspections, it
was found necessary at first for the chief dental surgeon to make frequent visits
to the headquarters of each division in the American training area. There he
inspected the office records, and the methods of the division dental surgeon, as
well as the headquarters dental clinic.^ At the same time he gave instructions
to remedy defects or to effect a development of the service. As these inspections
by the chief dental surgeon were later extended to include base hospitals, he
visited during the first six months of the American Expeditionary Forces, base
hospitals Nos. 15, 18, 21, 23, 31, 32, 36, and American Red Cross Hospital No. 1,
Neuilly. His personal inspections in training areas were made regularly until
March, 1918, when the chief surgeon's office was moved from general head-
quarters, Chaumont, to the headquarters of the Services of Supply at Tours. ^
SERVICE RENDERED
The character of the dental service in the American Expeditionary Forces
differed considerably in different zones and from time to time, depending on
resources and campaign activities.^ When the combat divisions were in training
areas it as possible to conduct a high-class tooth-conservation service, with a
view^ of rendering all men dentally fit for the period of the campaign.^ There-
fore, consistent efforts were made then to survey and record oral and dental
conditions for the entire personnel of organizations. These records were care-
fully studied so as to give priority for cases requiring oral prophylaxis as a health
measure; i. e., for extraction of broken-down teeth and roots, evacuation of
abscesses, and removal of rough calcareous deposits.^ This was followed later
by such filling operations for tooth conservation and masticatory restoration as
were deemed practicable.^ Later, when divisions entered combat areas, and
when dental outfits were reduced to combat equipment it was impossible to
give more than emergency treatment for the relief of pain, and dental service
was necessarily of a simpler character.^ On the march, and during actual
engagements, as already mentioned, dental officers and enlisted assistants
carried emergency kits, for the sole purpose of rendering immediate treatment,
which mainly consisted of extraction, minor surgical operations, medicinal
applications and sometimes plastic fillings, so that the soldier might return to the
front line without loss of time.^
During the armistice, when the troops had returned to rest and billeting
areas for the winter, the character of dental service again changed. More
careful consideration w^as now given to tooth conservation, through permanent
fillings, tooth restorations, and the construction of crow^ns, bridges, and den-
tures.^ Every effort was made to put the teeth of the men in first-class
condition, prior to their return to the United States and release from service.^
The number treated for the month of March, 1919, as compared with the
number treated in September, 1918, showed an approximate gain of 300 per
cent in dental activities and accomplishments.^ The former was a period of
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 121
rest, the latter one of active field operations. The consolidated report for
February, 1919, shows that during that month 119,792 persons were treated
and 183,031 dental operations performed.^
The service rendered at base hospitals was of high order at practically all
times. Their superior equipment materially enhanced the performance of high-
grade professional work, but during the stress of battle the dental service
rendered at these units and at evacuation hospitals consisted mainly in the
emergency treatment of wounded with special consideration of face and jaw
cases.
The practice of dentistry was carried on very thoroughly wherever modern
dental equipment, consisting of base dental outfits with electrical apparatus,
high-low base chairs, white-enamel steel cabinets and complete laboratories, was
installed.^ Such facilities were provided at the large dental clinics organized
in the base sections. Services of Supply, in embarkation areas, at hospital
centers and at several important headquarters.^
The various base section dental clinics and those at replacement depot, St.
Aignan, embarkation area, Le Mans, American University, Beaune, and at the
central dental infirmary, district of Paris, were organized for the purpose of
centralizing, standardizing, and directing dental service, for coordinating the
problems of equipment and supply, and for obtaining the greatest efficiency
through technical direction and by friendly competition.^ From 10 to 30
operators were occupied in these large clinics; they became show places of
great interest to visitors.^
Comparatively few dentures were required by the (approximately) 2,000,000
men in the American Expeditionary Forces, and those constructed were mostly
partial dentures for the replacement of a few lost teeth. The full dentures
required were less than 2 per cent of all dentures constructed.^
A consolidated report covering dental service rendered in the American
Expeditionary Forces from July, 1917, to May, 1919, inclusive, shows that a
total number of 1,396,957 persons were treated; 2,626,368 sittings were given;
497,948 treatments (medicinal) were administered; 2,013,580 operations per-
formed (which included 1,605,424 fillings and 384,427 extractions); and the
following prosthetic operations performed: 60,387 crown and bridge construc-
tions, including repairs and resets, and 13,140 denture construction and repairs. ^
In the early months of the American Expeditionary Forces, consideration
was given to the selection of certain base hospitals and providing those so
selected wath special personnel and appliances for handling the maxillofacial
cases of the American Army.^ The following hospitals were tentatively chosen
for this work: Base Hospital No. 18, Bazoilles; Base Hospital No. 15, Chau-
inont; Base Hospital No. 21, Dijon; Base Hospital No. 26, Angers; Base
Hospital No. 6, Bordeaux, and Base Hospital No. 8, Savenay.^ These units
were held in reserve for the accumulation of cases that would require evacua-
tion to the United States. ^ These plans were changed in May, 1918, upon
the arrival of the above-mentioned group of 40 specialists in general and dental
surgery for duty in the maxillofacial surgical service. These officers came over
under direction of a medical officer who was a well known specialist in this
line of surgery and who was soon designated chief consultant of maxillofacial
surgery, A. E. F.^
122
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The dental personnel of this group soon came under the adnunistrative
control of the dental division of the chief surgeon's office.^ The chief surgeon
decided to make temporary assignment of a medical and dental officer to each
of the several important centers in England, Belgium, and France, where this
work was being done, in order that they might observe and study the latest
method of procedure.^ They could be spared at this time because American
troops had not yet largely entered into active combat, nor had the special
equipment which these officers required, been received from the United States.^
Upon the return of these officers from their tours of observation, they were
organized by the chief surgeon into maxillofacial teams, each composed of one
surgeon and one dental surgeon, and were assigned to the important hospitals
or to hospital centers.^ The original plan of designating certain hospitals for
maxillofacial surgery w^as therefore abandoned, the new arrangement providing
that each important hospital center and every evacuation hospital would carry
on this work.^ Base Hospital No. 115, Vichy, was designated the "head hos-
pital," and an adequate group of surgical and dental specialists was sent there
to organize and develop it.^
Between 2,000 and 2,500 cases of face and jaw injuries occurred among
the American wounded.^ Of this number, about two-thirds treated in the
hospitals in France were cured, and were returned to duty there. ^ About
700 cases of severe type, requiring reconstruction operations, were evacuated
to the United States.^ The cases selected for such evacuation were of five
classes: First, compound, comminuted fractures of the jaw in process of con-
solidation and having splinted fixation; second, compound, comminuted
fractures, with delayed union due to sequestra, presence of infected teeth or
foreign bodies and requiring long-continued drainage — splinted with fixation;
third, united fractures with loss of bony substance, requiring bone graft or
prosthetic replacement — splinted with fixation; fourth, cases with healed scars
involving either of the conditions mentioned above and requiring a series of
plastic operations; fifth, cases of any of the above types, with extensive loss of
soft tissue partially healed and distorted, for corrective plastic operations.
The first convoy of these wounded embarked in October, 1918.^
The technique employed in the hospitals of the American Expeditionary
Forces for the treatment of the injuries classed in the foregoing categories was
based to a large degree upon that developed through the experience gained by
the French, British, Belgian, and Italian services, for in these armies, through
opportunities covering a period of four years, several men had become masters
in maxillofacial surgery.^
The selective methods of making bone grafts, in cases in which appreciable
loss of bony substance occurred, were of three types. ^ First, free graft from
a rib, the tibia, or the crest of the ilium; second, osteoperiosteal grafts from
the tibia; third, pedicled graft from the mandible itself, shifted into position.^
Some form of splint was used in all these cases to assure fixation of fragments
in normal relation.^ The policy ultimately adopted for this class of cases con-
templated that the simpler ones would all be cared for in the hospitals in the
American Expeditionary Forces and that the severer cases, after the first stages
of the work, would be evacuated to a hospital at a base port, where they w^ould
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 123
receive the properly adjusted "open bite" splints to prepare them for the
ocean voyage.^ In this connection, it should be remarked that none of the
"closed bite" splints could be used in these cases, for it was feared that because
of seasickness they would endanger the life of the patients through subjecting
them to strangulation by vomitus.-
Many types of splints were made for these cases and many names were
given to the several types. ^ With a view of standardizing them, the follow-
ing terms were finally adopted: Interdental splints were splints made for
one jaw, either upper or lower. Intermaxillary splints were those made for
both upper and lower jaw and connected by some mechanical method for
fixation.- This latter type was made for both the "open-bite" method and
the "closed-bite" method, to meet requirements, and, as many of the cases
required at different times both the open- and closed-bite splint, a combination
splint was devised which could be used in either circumstance.^ This splint
was provided with lock pins through the bicuspid region, which held the upper
and lower parts firmly together as a closed bite, but when the pins were with-
drawn and the jaws opened, the insertion of metal stilts to retain the open
bite was feasible. These stilts were firmly held in position by the reinsertion
of the lock pins.^
PERSONNEL "
(July 28, 1917, to July 15, 1919)
Col. Robert T. Oliver, D. C, chief.
Lieut. Col. William S. Rice, D. C.
Maj. Richard K. Thompson, D. C.
First Lieut. John D. Brown, D. C.
REFERENCES
(1) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 28,
1917. Subject: Weekly war diary. On file, Historical Division, S. G. O.
(2) Report from Col. Robert T. Oliver, D. C, chief of the dental service, A. E. F., to the
Surgeon General, U. S. A., April 13, 1921. Subject: The dental service. On file.
Historical Division, S. G. O.
(3) Letter from The Adjutant General to the Surgeon General, June 19, 1917. Subject:
Extract from cablegram (cipher cable) received at War Dept., from Page to Sec-
retary of State, London, June 12, 1917. On file, Record Room, S. G. O. (138036).
(4) Confidential Orders, No. 2, par. 2, War Department, Washington, D. C, June 25, 1917.
On file, Personnel Record, Personnel Division, S. G. O.
(5) Par. 8, Special Orders, No. 76, general headquarters, A. E. F., August 23, 1917.
(6) Report from Brig. Gen. Jefferson R. Kean, M. C, to the chief surgeon, A. E. F.,
April 24, 1919. Subject: Data to be used bj- military board of allied supply. Copy
on file. Historical Division, S. G. O.
(7) Par. 77, Special Orders, No. 37, headquarters, intermediate Section, Nevers, A. E. F.,
April, 1918. On file, A. G. O., World War Division, Intermediate Section (Special
Orders) .
(8) Report from the chief surgeon, A. E. F., to the Surgeon General, L^. S. A., May 1, 1919.
Subject: Activities of the chief surgeon's office to May 1, 1919. On file. Historical
Division, S. G. O.
" In this list have been included the names of those who at one time or another were assigned to the division during
the period July 28, 1917, to July 15, 1919.
There are two primary groups — the heads of the division or the section and the assistants. In each group names
have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
CHAPTER YII
THE NURSING SECTION; RECONSTRUCTION AIDES
THE ARMY NURSE CORPS
The few hundred nurses who formed a part of the six base hospital units
assigned to service with the British Expeditionary Forces, and the other nurses
who arrived in France during the early period of the American Expeditionary
Forces, were for five months under the general jurisdiction of the office of the
chief surgeon, A. E. F., after that office was established in June, 1917, ^ and
of its personnel division after that division was created in July.^ On October 2,
1917, General Pershing cabled to the War Department a request that a com-
petent member of the Army Nurse Corps be sent to Paris to serve as superin-
tendent of nurses of the American Expeditionary Forces.^
The chief nurse of Walter Reed Hospital was selected for this assignment
and, with an assistant, reported for duty on November 14, 1917, at head-
quarters, line of communications (then in Paris), and on the day following
was assigned as chief nurse, line of communications.^ At the time in question,
most of the nurses of the American Expeditionary Forces were on duty at base
hospitals in France, and these (other than the six above mentioned) were
under the administrative control of the chief surgeon, line of communications.*
When headquarters, line of communications, moved to Tours in January,
1918, the office of the chief nurse accompanied it as a part of the personnel
division, office of the chief surgeon, line of communications.* No member of
the Army Nurse Corps served in the office of the chief surgeon, A. E. F., until
that office moved to Tours and there absorbed the office of the chief surgeon,
line of communications, in March, 1918.* The office of the chief nurse then
became a section of the personnel division, chief surgeon's office.*
On October 8, 1918, the Surgeon General notified the chief surgeon that
authority had been received from the Secretary of War for the appointment
of a director and two assistant directors of the nursing service in France, and
for a director and two assistants for our nursing service in base section No. 3
(England).' No such appointments were made in base section No. 3, however,
for the chief surgeon of that section decided that so many administrators for
the nursing service there were unnecessary and, therefore, continued in that
section the office of chief nurse which had been established there June 17,
1918.' The chief nurse of the American Red Cross in France, who formerly
had been chief nurse of Base Hospital No. 21, was appointed director of the
nursing service, A. E. F., and on November 15, 1918, reported to the chief
surgeon, A. E. F., at Tours,' thus replacing the chief nurse, A. E. F., who left,
on December 2, to become assistant to the superintendent of the Army Nurse
Corps in the Surgeon General's office.' The chief nurse of base section No. 3
and a nurse who had been assistant to the chief nurse were appointed assist-
ant directors of the nursing service, A. E. F., November 18 and December 14,
125
126
ADMIXISTRATIOX, AMERICAN' FA'PEDITIOXAKV FORCES
respectively.' The staff of the director of the nursing service, was fiirtlier
augmented by assigning to it, on January 13, 1919, a nurse from Base Hospital
No. 7, who formerly had been matron of General Hospital No. 22, British
Expeditionary Forces, and, on February 3, 1919, the chief nurse of Base Hospi-
tal No. 27, the duties of the last-mentioned member of this staff including both
service at the central office and inspection of the nursing service in hospitals.^
Most of the nurses who served in the American Expeditionary Forces
arrived as members of base hospital units, but others came in replacement
units, and were not attached to any hospital until assigned in France.' Others
sailed as casuals (one group of these, which arrived in the summer of 1918,
including 500 nurses) and a few as members of small organizations such
as mobile operating units, psychiatric units, etc.; one group consisted of
anesthetists.'
On August 11, 1917, the chief surgeon, when submitting to the chief of
staff, A. E. F., an estimate of the medical personnel that would be necessary
for an army of 1,000,000 men, calculated that the number of nurses required
for such a force would be 22,430; however, at no time did the quota of nurses
approximate this estimate.*
In the first six months after the United States entered the war a few more
than 1,100 nurses arrived, of whom about half served in the six base hospitals
assigned to the British.' From November, 1917, until March 31, 1918, less
than 900 others arrived, and there was a consequent shortage on that date of
400, even under the reduced priority schedule prescribed by the general staff,
A. E. F.' At this time there were only 2,088 nurses in France, of whom approx-
imately 700 were under British control.'
The consequent shortage of nurses in the American Expeditionary Forces
was due primarily to the great need for combatants and to lack of transport
facilities.* At times there were as many as 1,400 nurses in the mobilization
station in New York, awaiting transportation, several groups being thus de-
tained as long as three months.^ By the middle of April, when the shortage
of Medical Department personnel had become so acute that a breakdown in
its service was threatened, the shortage of nurses was estimated at 1,121.' On
May 3 a cable was sent asking that 555 be sent immediately. '
On June 30, 1918, nurses serving in Europe, or designated for foreign
service, were distributed as follows:^ British forces, 755; French forces, 14;
American forces, 3,323; awaiting transportation or en route to mobilization
station, 1,258; total, 5,350. This number included nurses sent to the American
Red Cross Military Hospitals Nos. 1,2, and 3.^
Because of the increase of our combat activities in the ensuing weeks,
Medical Department personnel was engaged to such an extent that on July 27,
1918, the chief surgeon reported that the resources of the Medical Department
were practically exhausted in so far as personnel was concerned, and on August
10 a cable was sent from general headquarters, requesting absolute priority for
medical organizations, including 2,312 nurses.' During that month, 1,000
nurses arrived in France.'
Under date of September 21, the personnel division reported that the
shortage of nurses continued to be acute ; all hospital units were short of nurses
and demands were being made by camp hospitals for large numbers of them
ORGANIZATION' AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 127
because of the epidemic of influenza.*^ It was impossible, of course, to furnish
all the nurses requisitioned by various organizations.^
When the armistice was signed there was a total of 8,587 nurses on duty
overseas, the number short of actual needs being approximately 6,925;^ the
number of patients in hospital under treatment on November 12 totaled 193,-
026, distributed in 153 base hospitals, 66 camp hospitals, and 12 convalescent
camps. ^ The number of nurses on duty in the hospital centers, where the
largest number of patients were grouped at this time, was as follows:' At
Mesves hospital center where patients in 10 base hospitals and in the con-
valescent camp numbered 20,186 on November 16, the center's peak day,
there were 394 nurses.' At Mars hospital center, on November 16, in six
hospitals and in the convalescent camps, 14,302 patients were cared for by
493 nurses.' At Allerey, on the 17th, in 6 hospitals and in the convalescent
camp, there were 17,140 patients, cared for by 360 nurses, and at Toul on the
28th of November, in 7 hospitals there were 10,963 patients, cared for by 320
nurses.' The maximum number of nurses at certain centers at one time was:
Mesves, 650 on January 4, 1919; Mars, 642 on December 4, 1918; Toul, 438 on
February 1, 1919.'
Between November 11, 1918, and January 25, 1919, when the greatest num-
ber of nurses was on duty in the American Expeditionary Forces, nearly 1,500
nurses arrived — more than the total number received in 1917.* The greatest
number of nurses reached in the American Expeditionary Forces was recorded
in the week ending January 11, 1919, when their number totaled 10,081, includ-
ing approximately 700 on duty with the British.* This total should show as
of the first week in December, for there were no arrivals subsequent to that
date.^ At this time the strength of the American Expeditionary Forces was
approximately 1,750,000 men.^ With the exception of casual nurses who were
separated for various reasons, the first group which left France was that with
Base Hospital No. 2, which sailed early in January, 1919.' From that time
the return of nurses was gradual, averaging from January through April, 1919,
about 200 nurses a week.' During the last week of April over 800 nurses sailed.'
No chief nurse was appointed for any of the sections of the Services of Supply
except base section No. 3.*
One of the important developments of the nursing service in France was
the appointment of a chief nurse at some of the hospital centers.' This plan,
which was not prescribed in orders from higher authority, developed at the
several centers independently, in an informal manner in November, 1918, and
was a natural result of the grouping at each center of several hospitals under
a general command.' It developed to different degrees in the several centers
and was apparently of value in every place where it was tried, except that in
one or two instances the center chief nurse was unable to secure cooperation.^
The plan w^as adopted at the following centers:' Allerey, Bazoilles, Beau
Desert, Mars, Mesves, Nantes, Savenay, Toul, Vichy.
Center chief nurses acted as assistants to the director of nursing service.
At Mesves her duties were prescribed as follows: '
1. To assist the commanding officer of the center in such matters pertaining to the
Juirses of the center as he may see fit to assign to her.
13901—27 9
128
ADMINISTRATION, AMERICAN EXPEDITIOXAHY FORCES
2. To assist in the distribution and readjustment of nurses witliin tlic center, aceordniK
to the pressure of work in the various hospitals.
3. To keep informed by frequent visits of the conditions in the hospitals of the center,
as they affect the nursing personnel such as quarters, the mess, means of recreation, care of
sick nurses, etc.
4. To bring to the attention of the director of nursing service, after consultation with
the commanding officer of the center, any matters which seem to need special adjustment.
5. To act as chairman of a committee of chief nurses of the center. This committee
will make suggestions for regulations governing the conduct, and social relations of nurses,
which shall be, as far as possible, uniform for the entire center. These suggestions should
be presented to the commanding officers for their approval and indorsement. The object
of this committee will be to promote the welfare of the nurses within the center, and to
maintain a high standard of service and conduct within the Army Nurse Corps.
6. To act as hostess of the center. In that capacity she will meet each new chief nurse
arriving at the center and see that the latter has all information that will assist her in the
performance of her duties. She will also, in cooperation with the commanding oflScers and
chief nurses of the center, endeavor to promote a wholesome social life among the nurses.
Similarly, as prescribed by regulations, a chief nurse was designated for
each hospital where a group of nurses was on duty, whether mobile, evacua-
tion or base, and whether it was part of a center or operatmg independently.'
Experience showed that the nursing units definitely organized by a head
nurse in civil hospitals and colleges, among women who were accustomed to
work together were more quickly efficient than were those composed of casuals
gathered from many sources.' The latter, with no previous division of assign-
ments according to the particular qualifications of each member were inevitably
handicapped at first by a lack of mutual acquaintanceship.'
RECONSTRUCTION AIDES
The employment of reconstruction aides was an innovation during the World
War, and it was not until during the armistice that any great use of them
was made overseas.
A memorandum published December 31, 1917, by the Surgeon General,
covering the organization under the division of military orthopedic surgery, and
giving the duties, status, etc., of the "woman's auxiliary medical aides," was given
application in the American Expeditionary Forces. These aides were engaged
in physiotherapy work."' Their designation was changed to "reconstruction
aides," and some of the provisions for their employment were modified by the
Surgeon General on January 22, 1918."
On May 3, 1918, the Surgeon General authorized the chief medical officer
of each army or separate auxiliary force '^ to appoint head aides, not to exceed
two to each hospital, from among the reconstruction aides serving overseas.
On May 21, 1918, the chief surgeon, A. E. F., initiated a cabled requisition
for 30 reconstruction aides for service in overseas orthopedic hospitals.'^ This
request received a favorable reply, '^ but several months elapsed before they began
arrive in numbers. This led the senior consultants to try and secure them
through the American Red Cross. On July 13, the director of professional serv-
ices was notified that the senior consultants of special services should look far
enough ahead to prevent the employment of aides from the Red Cross, thus neces-
sitating that organization cabling to the United States for replacements.'*
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 129
Kequirements for reconstruction aides who were engaged in occupational therapy
work, were outlined in a circular published by the Surgeon General, August 8,
1918. '*^
Early in August a request was cabled that 20 reconstruction aides be sent
over with each base hospital, half of them to be trained in physiotherapy^ and
half in occupational therapy. These aides were to be carried as civilian em-
ployees and not included in the reports and returns of nurses. Toward the end
of that month the senior consultant in orthopedic surgery was notified that the
Surgeon General was organizing reconstruction aides in groups of 20 members
each and that these groups would be sent as fast as possible to the American Ex-
peditionary Forces, as enumerated units, for further reassignment there. A
reconstruction aide unit arrived at Havre, October 19.^" Certain aides had arrived
before that date but from that time forward their numbers increased consider-
ably. Upon arrival they were assigned to hospitals and hospital centers.
The supervisor of reconstruction aides was at first located at Savenay^^ but
in January, 1919, joined the chief surgeon's office at Tours. ^ All occupational
therapy aides for overseas service were versed in simple bedside handicrafts.
The reconstruction aides were under the direct supervision of the director,
nursing service, their function being to carry out instructions in the rehabili-
tation of wounded in methods of physical and occupational therapy." When
practicable they were quartered at the hospitals and were entitled to rations, to
the laundering of uniforms, to transportation; also they were entitled to $4 per
day when traveling. They w^ere authorized to purchase Quartermaster Depart-
ment supplies on written approval of the commanding officer, but were not
entitled to heat and light. The reconstruction aides had the same pay as
nurses, and increase of pay was applied to them as well.^*
On December 29, 1918, there were 200 reconstruction aides serving in the
American Expeditionary Forces, distributed among 20 base hospitals. By
March 15, 1919, this number had been reduced to 93, of whom 71 were engaged
in physical therapy and 22 in occupational therapy.^® These aides were then
attached to 10 hospitals distributed among 6 hospital centers. On May 1,
1919, there were 109 aides in the Services of Supply (55 occupational, 54 physi-
otherapy) distributed among 14 hospitals. Thirty other reconstruction aides
were at that time on duty with the Third Army in Germany."
On June 18, 1919, the chief surgeon. Third Army, was notified that recon-
struction aides were not now considered civilian employees and that they were
to be returned to the United States before June 30.^^
.See Circular No. 56, chief surgeon's office, Nov. 19, 1918, quoted in the appendix.
130
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL"
(July 28, 1917, to July 15, 1919)
ARMY NURSE CORPS
Bessie S. Bell, chief nurse, A. N. C.
Julia C. Stimson, director, nursing service.
Nina E. Shelton, assistant director, nursing service.
Blanche S. Roulon, chief nurse.
Arma E. Coffee, assistant chief nurse.
Marion G. Parsons, nurse.
SUPERVISOR, RECONSTRUCTION AIDES
Marguerite Sanderson.
REFERENCES
(1) Report from Julia C. Stiinsou, Res. A. N. C, director of nursing service, A. E. F., to
the Surgeon General, U. S. A., May 31, 1919. Subject: Nursing activities, A. E. F.,
on the Western Front, from May 8, 1917, to May 31, 1919. On file. Historical Divi-
sion, S. G. O.
(2) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 28,
1917. Subject: Weekly war diary. On file. Historical Division, S. G. O.
(3) Cable No. 197, par. 3, from Gen. John J. Pershing, to The Adjutant General, October
2, 1917.
(4) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file.
Historical Division, S. G. O.
(.5) Annual Report of the Surgeon General, U. S. Army, 1918, 429.
(6) Weekly war diary, chief surgeon's office, A. E. F., September 21, 1918.
(7) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April 17,
1919. Subject: The Medical Department, A. E. F., to November 11, 1918. On
file, Historical Division, S. G. O.
(8) Final report of Gen. John J. Pershing, September 1, 1919, 77.
(9) Report of "Strength of the A. E. F. by months as shown by the consolidated returns
for the A. E. F.," January 12, 1924. On file, A. G. O., Returns Section, Miscellane-
ous Division.
(10) "Circular of information concerning the woman's auxiliary medical aides," the Sur-
geon General's Office, December 31, 1917. On file. Historical Division, S. G. 0.
(11) "Circular of information concerning the employment of reconstruction aides, Medical
Department, U. S. Army," the Surgeon General's Office, January 22, 1918. On
file. Historical Division, S. G. O.
(12) Memorandum from the Surgeon General of the Army to the Supply Division, S. G. 0.,
May 3, 1918. Subject: Approval of letter of appointment for reconstruction aides.
On file, Historical Division, S. G. O.
(13) Cable No. 1153-S, subpar. A, from General Pershing to The Adjutant General of the
Army, May 21, 1918.
(14) Cable No. 1434-R, par. 4, from The Adjutant General of the Army, June 3, 1918, to
General Pershing. On file, A. G. O., World War Division, chief surgeon's files,
(231.238).
" In this list have been included the names of those who at one time or another were assigned to the division during
the period July 28, 191", to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names
have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 131
(15) Third indorsement from the chief surgeon, A. E. F., to director of professional services,
A. E. F., July 13, 1918; on letter from the senior consultant, orthopedic surgery,
A. E. F., to the chief surgeon, A. E. F., July 11, 1918. Subject: Reconstruction
aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).
(16) Circular, "Reconstruction aides in occupational therapy," Office of the Surgeon Gen-
eral, August 8, 1918. On file, Historical Division, S. G. O.
(17) Cable No. 1546-S, par. 9, from General Pershing to The Adjutant General of the
Army, August 2, 1918.
(18) First indorsement from the chief surgeon, A. E. F., to the commanding officer of Base
Hospital No. 9, August 6, 1918; on letter from the commanding officer, Base Hospi-
tal No. 9, A. E. F., to the chief surgeon, A. E. F., August 2, 1918. Subject: Recon-
struction aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).
(19) Letter from the chief surgeon, A. E. F., to senior consultant in orthopedics, August 28,
1918. Subject: Reconstruction aides. On file, A. G. O., World War Division,
chief surgeon's files (231.238).
(20) Telegram from senior consultant in orthopedic surgery, A. E. F., to the chief surgeon,
A. E. F., October 15, 1918. On file, A. G. O., World War Division, chief surgeon's
files (231.238).
(21) Memorandum from the commanding general, A. E. F., to the chief surgeon, A. E. F.,
November 4, 1918. Subject: Contract and oath of office taken by reconstruction
aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).
(22) Cable No. 267-R, par. 3, from The Adjutant General of the Army, to General Persh-
ing, November 14, 1918. On file, A. G. O., World War Division, chief surgeon's
files (231.238).
(23) Second indorsement, from the chief surgeon's office to the commanding officer. Base
Hospital No. 94, U. S. A. P. O., 713-A, France, January 30, 1919; on letter from the
personnel officer, Base Hospital No. 94, to the chief surgeon, A. E. F., January 30,
1919. Subject: Pay of reconstruction aides. On file, A. G. O., World War Divi-
sion, chief surgeon's files (231.238).
(24) Telegram from the chief surgeon, A. E. F., to the chief surgeon of the advance section,
A. E. F., December 21, 1918. On file, A. G. O., World War Division, chief sur-
geon's files (248).
(25) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to
the chief surgeon, A. E. F., December 29, 1918. On file, Historical Division, S. G. O.
(26) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to
the chief surgeon, A. E. F., March 15, 1919. On file. Historical Division, S. G. O.
(27) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to
the chief surgeon, A. E. F., May 1, 1919. On file. Historical Division, S. G. O.
(28) Telegram from the chief surgeon, A. E. F., to the chief surgeon of the Third Army,
June 18, 1919. On file, A. G. O., World War Division, chief surgeon's files (230.366).
CHAPTER VIII
THE DIVISION OF SANITATION AND INSPECTION"
ORGANIZATION
The division of sanitation, chief surgeon's office, A. E. F., eventually became,
in very large degree, an office of preventive medicine wherein all activities
relating to that subject were centralized.' However, this centralization was
not complete until December 26, 1918, when there w^as transferred to the sanita-
tion division the subsection of venereal diseases, which in the division of urology
had theretofore pertained, with the other professional services, to the division
of hospitalization. -
Ch aut UI.— Scheme for organization of division of sanitation and inspection, chief surgeon's office, A. E. F.
When the chief surgeon's office, A. E. F., was organized, July 28, 1917, the
prescribed activities of the division of sanitation were as follows:^ In charge
of sanitation of camps and quarters, laundries, disinfection and delousing,
health of command, report of sick and wounded, statistics and sanitary reports.
Subsequently these activities were somewhat modified, several of them being
transferred from the Medical Department to other departments of the Ameri-
can Expeditionary Forces. Thus, General Orders, No. 31, G. H. Q., A. E. F.,
January 21, 1918, directed the provision and operation of laundries be vested
in the Quartermaster Corps, and that portable shower baths, taken by organiza-
tions into the zone of the advance, be installed when necessary by the engineers.
General Orders, No. 60, G. H. Q., A. E. F., April 20, 1918, provided that the
personnel of portable disinfestors be furnished by the engineers, and that of
portable laundries and bathing units by the Quartermaster Corps. Concur-
rently with this transfer of some of its responsibilities, the sanitation division
assumed others which had not pertained to it originally.^ By General Orders,
No. 29, G. H. Q., A. E. F., February 14, 1918, general sanitary inspectors were
provided for, and though these officers reported on a wide range of subjects,
in addition to sanitation, they were essentially a part of the division of sanitation.
» Consult also Sec. H, Vol. VI, of this history, wherein a fuller consideration is given the activities of this division.
133
134
ADMINISTRATION, AMERICAN EXPEDITK )N A H V FORCES
On March 6, 1918, the chief surgeon prescribed that the division of sanita-
tion be organized into the following sections:^ (1) Sick and wounded records;
(2) laboratories and infectious diseases; (3) inspection; (4) epidemiology.
Though the last-mentioned section was estabhshed while the chief surgeon's
office was yet at Chaumont — that is, during the early part of March — this out-
lined organization was not effected immediately.^ On March 31, the division
of sanitation was redesignated the division of sanitation, sanitary inspection,
and sanitary statistics, with duties more clearly defined and established than
they had been during the formative stage of its activities.* On May 5, 1918,
the laboratory service was separated from the other professional services* with
which it formerly had been operating under the division of hospitalization, to
become a part of the division of sanitation, though formal orders concerning
this transfer, and the reorganization of the section of laboratories and infectious
diseases as a part of the division of sanitation, were not published until July 20,
1918.^
The organization outlined above was retained until December 26, 1918,
when, as previously stated, the division of urology was transferred to the division
of sanitation from that of the professional services.^
ADMINISTRATIVE FUNCTIONS
In view of the organization described above, the administrative functions
which were included within the jurisdiction of the division of sanitation and
inspection may be classified as follows: ^
(0) The receipt, record, and analysis of reports of disease and injury.
(6) The receipt and review of monthly and special sanitary reports.
(c) The selection, supply, and direction of laboratory services for the prevention, diag-
nosis, and treatment of disease, for the protection of water and food supplies, and for research
by experimental laboratory methods in all matters pertaining to personal hygiene, physiology,
the science of nutrition, pathology, and bacteriology, as they bore upon the problems of the
armies.
(d) Inspection of areas and premises occupied by the troops together with such exami-
nation of men, singly, or in groups, as was required in tracing the origin, distribution, and
spread of causes of nonefFectiveness, whether due to communicable disease or to other cause.
(e) Correlation of the reports of disease with the reports of sanitary conditions, troop
movements, weather conditions, military operations, or other essential factors, to the end
that epidemics might be brought to an end promptly and their recurrence prevented.
(/) Collection of data for statistical purposes to serve as a basis for the direction of
sanitary policies during the present emergency, and for the service of students and adminis-
trators in the future.
(g) The selection, training, and appointment of qualified officers and enlisted men to
serve the functions above described.
(h) Collection and publication of information dealing with preventive medicine.
(1) Maintenance of liaison with other divisions of the Medical Department.
0") Maintenance of liaison with the medical services, both civilian and military, of our
Allies, and with conditions of disease among our enemies, which might affect the health of our
troops.
OFFICE CONTROL
Cummunications betw^een the division of sanitation and inspection and
other divisions of the Medical Department passed through the office of the chief
of the division. All but routine reports were submitted direct to the chief of
the division.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 135
By central control of correspondence and of reports concerning personnel
and supplies, at the offices of the chief of the division, and of the director of
laboratories, provision was made and responsibility placed, for all actions
taken. ^
MEETINGS AND LIAISON
Meetings of the heads of the subdivisions at the office of the sanitation
division, at Tours, or at the central Medical Department laboratory, at Dijon,
provided frequent opportunity for the discussions of new problems and agree-
ment upon policies affecting the division of sanitation. ^ Through the deputy
of the chief surgeon, at General Headquarters, the chief of the division of
sanitation was kept constantly informed of the changing problems of the general
staff.^ Through the surgeons of armies, or of the administrative sections of
the Services of Supply, he was kept in touch with the needs of combat troops
and of organizations in the Services of Supply, from the moment of their arrival
at the ports of debarkation, to arrival at their station in the Services of Supply,
or at the front. ^ Officers, — e. g., sanitary inspectors and laboratory experts —
charged with duties pertaining to the sanitary services, were assigned to the
larger organizations of combat troops, to sections of the Services of Supply, to
hospital centers, training areas, and other large commands.'' When the size
of an organization did not justify the assignment of an officer to such service
exclusively, one was charged with sanitary services of the command in addition
to his other duties.^ Officers charged with sanitary duties thus served all com-
mands from the largest to the smallest, and through these agencies, by successive
echelons of responsibility, the sanitation division exercised appropriate super-
vision in its specialty over all elements of the American Expeditionary Forces.^
Close contact existed between the divisions of sanitation and hospitaliza-
tion, particularly in matters pertaining to infectious diseases.' These included
the venereal diseases, after the subsection charged with that specialty was
transferred to the division of sanitation as described above. The laboratory
division was in especially close liaison with the professional services.''
The location of the headquarters of the division of laboratories and infec-
tious diseases at Dijon, while the office of the chief surgeon was located at
Chaumont, and then at Tours, caused at times, especially after the chief
surgeon's office moved to Tours, delay and inconvenience to the office of sick
and wounded and that of epidemiology, but difficulties in communication
were reduced to a minimum by the almost daily telephonic and telegraphic
communication, exchange of reports, and the frequent conferences held by the
heads of the subdivision.^
The sanitation division also maintained close contact, in matters pertain-
ing to bathing and disinfestation, with the Quartermaster Department,^ and
through its laboratory division with the laboratories of the Chemical Warfare
Service.*
The division also maintained contact with the French civil and miUtary
services, in matters pertaining to sanitation and epidemiology, through the
medical officers of the French military missions at general headquarters and
at headquarters, Services of Supply, and through the French medical officers
in each of the French regions in which American troops were stationed, or
through which they passed.^
136
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
PERSONNEL "
(July 28, 1917, to July 15, 1919)
Brig. Gen. Walter D. McCaw, M. C, chief.
Col. Percy M. Ashburn, M. C, chief.
Col. Daniel W. Harmon, M. C, chief.
Col. Henry A. Shaw, M. C, chief.
Col. Haven Emerson, M. C.
Col. Henry C. Fisher, M. C.
Col. Daniel W. Harmon, M. C.
Col. Paul C. Hutton, M. C.
Col. Howard H. Johnson, M. C.
Col. James C. Magee, M. C.
Col. Robert U. Patterson, M. C.
Col. George Walker, M. C.
Col. Linsley R. Williams, M. C.
Maj. George Blackburne, M. C.
Maj. Robert H. Delafield, San. Corps.
Maj. John S. C. Fielden, jr., M. C.
Maj. Bascom Johnson, San. Corps.
Maj. Frank A. Ross, San. Corps.
Capt. George J. Anderson, San. Corps.
Capt. T. L. Harrington, M. C.
First Lieut. Howard H. Antles, San. Corps.
First Lieut. Arthur B. Crean, San. Corps.
First Lieut. Arthur E. Nelson, San. Corps.
First Lieut. Dennison Walcott, San. Corps.
REFERENCES
(1) Report from Lieut. Col. J. F. Siler, M. C, director of laboratories and infectious dis-
eases, A. E. F., to the chief surgeon, A. E. F. (undated). Subject: Activities of
the division of laboratories and infectious diseases, from August, 1917, to July, 1919.
On file, Historical Division, S. G. O.
(2) Report of the division of sanitation and inspection, Medical Department, A. E. F.,
May 31, 1919, by Col. Haven Emerson, M. C. On file. Historical Division, S. G. 0.
(3) Report from the chief surgeon, A. E. F., to the commanding general. Headquarters,
A. E. F., April 17, 1919. Subject: The Medical Department, A. E. F., to November
11, 1918. On file. Historical Division, S. G. O.
(4) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., April 1,
1918. Subject: War diarv for week ending March 31, 1918. On file. Historical
Division, S. G. O.
(5) Circular No. 25, chief surgeon's office, A. E. F., Mav 5, 1918. On file, Historical Divi-
sion, S. G. O.
(6) Circular No. 40, chief surgeon's office, A. E. F., Julv 20, 1918. On file. Historical Divi-
sion, S. G. O.
(7) Report on " Sanitary reports, monthly and special," October 7, 1921, by Col. Haven
Emerson, M. C. On file, Historical Division, S. G. O.
(8) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file, Historical Division, S. G. O.
(9) Letter from the chief surgeon, A. E. F., to Sous-Secretaire d'Etat du Service de Sante,
section Franco-Americaine French mission, G. H. Q., A. E. F., March 8, 1919. Sub-
ject: Epidemic diseases in the A. E. F. On file, A. G. O., World War Division, chief
surgeon's files, 710.
" In this list have been included the names of those who at one time or another were assigned to the division during
the period July 28, 1917, to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names have
been arranged alphabetically, by grades, irrespective of chronological sequence of service.
CHAPTER IX
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
GENERAL ORGANIZATION
When the United States entered the war, practically no information was
available to us relative to the laboratory organization and activities of the
nations engaged. Therefore, it was not possible for the Medical Department
to formulate at that time any definite plan of organization based on their
experience ; however, as a preliminary measure to the provision of a laboratory
service for the American Expeditionary Forces, the officers in charge of the
laboratory division, Surgeon General's office, assembled the personnel for an
initial laboratory and dispatched it to France.' This unit which sailed on July
26, 1917, and arrived in France on August 5, consisted of five officers and six
enlisted men under command of a major of the Medical Corps. Designated
as Army Laboratory No. 1, it was assigned to station at Neuf chateau about 35
miles north of Chaumont.' As the officer in charge of the laboratory division,
Surgeon General's office, had believed that general laboratory supplies would be
available in France, this unit brought with it only a few special items and pro-
cured from the Pasteur Institute in Paris an emergency equipment consisting
of one French Army model field laboratory packed in chests.' This equipment
provided very limited material for clinical pathology and general bacteriology,
and only with the greatest difficulty was a very incomplete equipment for
neurologic and pathologic work procured.' A small requisiCion had been placed
with the supply division of the wSurgeon General's office before this unit left
the United States, but much of this never reached the laboratory in France.'
A requisition was placed for the limited number of items of laboratory equipment
on the Medical Department supply table, and provision was made for the sup-
ply of a standard cantonment laboratory to corps laboratories, and the Army
standard field laboratory equipment (plus a poison detection chest) to mobile
laboratory units, as they were ordered overseas.' Army Laboratory No. 1 was
obliged to occupy a building altogether unsuitable for its purposes, where nec-
essary alterations were made under almost insurmountable difficulties. Neither
gas nor electricity was available with sufficient constancy to permit their use.'
The commanding officer of this unit, who was also the adviser of the chief
surgeon, A. E. F., in all matters pertaining to laboratory service,' formulated a
tentative plan for the laboratory organizations of the American Expeditionary
Forces, which was submitted to the Surgeon General in the following letter:^
1. This letter * * * is intended to furnish your office with an approximate idea
of the officers, men, and supplies needed in France for the laboratory work of an army on the
l)asis of five corps of six divisions each — a total of approximately 1,000,000 men.
PERSONNEL
(a) It is planned to establish one army laboratory with a personnel of 8 officers and 16
men, which will be the central laboratory, fully equipped for all kinds of routine special work,
including research. The laboratory detachment and supplies brought over by Major Nichols
will serve as the nucleus for this laboratory.
137
138
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(b) This office has recommended the establishment of five corps laboratories with a
personnel of 4 officers and 8 men each. These laboratories will be stationary and will need
to have an equipment less complete than that of the central army laboratory, V)ut sufficient
for all routine w'ork. They may be specialized under direction of the army laboratory, if the
routine work of the corps permits.
(c) A field laboratory with two officers and four men each will be provided and attached
to each division. The field laboratory will be mobile and its principal work will be the bac-
teriological and chemical examination of water, the taking of cultures and specimens for
examination in the corps or army laboratory, the examination of smears, etc. The field
laboratories will depend upon and look to the corps and army laboratories for supplies and
supervision of technique, etc.
(d) Summary of personnel —
Number
Officers
Men
Army laboratory (8 officers, 16 men)
1
8
20
16
Corps laboratories (4 officers, 8 men)
5
40
Field laboratories (2 officers, 4 men)
30
60
120
Total
88
176
(e) Chemist. — It is planned to include in the work of the organization given above,
all chemical work which is of great importance in this war and which in the English and
French services is done by separate organizations. It is believed that all laboratory work
can be combined to advantage in our service. For this work officers and men, chemists
of the Sanitary Corps, can be used as follows:
Number Officers
Army laboratory. _
Corps laboratories -
Field laboratories..
SUPPLIES
(a) The supplies for the army laboratory have already been partly arranged for by
a requisition prepared by Major Nichols and submitted before his departure from the United
States. Further requisitions will be made on Washington for this laboratory later.
(b) At present, as our own laboratory supplies will not be avaiable for issue for some
time, work will be started near the established training camp with a laboratory outfit which
has been obtained by purchase from the Pasteur Institute. Emergency items, as they may
be needed, will be obtained here by purchase from the Pasteur Institute or elsewhere.
(c) It is desired that the equipment of the corps laboratories shall be the same as that
already adopted for the cantonment laboratories in the United States. It is believed that
the simplest method of requisition is to ask for five of these outfits.
(d) The standard field laboratory equipment can be used for the field laboratories
with the addition of a chest for the detection of mineral poisons. It might be possible
to obtain these here, but it is preferable to have them sent from the United States. It
is planned to purchase here two motor laboratories, similar to those used in the English
service, * * * f^j. trial; but it is believed that our field laboratory can be used with-
out a special car by transporting it on a light truck or ambulance.
(e) Laboratory supplies to replace those expended will be asked for by the medical
supply officer from time to time according to strength as authorized by the supply table.
2. To recapitulate: For the whole laboratory organization there w'ill be required
about 50 medical officers and 130 men capable of doing routine laboratory work, and 35
officers and 45 men of the Sanitary Corps capable of doing chemical work. These should
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 139
be sent to PVancc so that the required personnel for each division field laboratory will accom-
pany each division. The army laboratory, Major Nichols in charge, will do the work
of the corps laboratories until the latter can be established. There is immediate need for
two chemists to start their part of the central army laboratory organization.
(a) Advance notice of all arrivals should be sent, to facilitate the assignment of labora-
tory personnel.
3. In regard to supplies, there will be needed 30 more field laboratories each with a
small, suitable chemical chest for qualitative analysis for mineral poisons, to be provided
in the United States.
(a) The question of the transportation of field laboratories will be made the subject
of a later communication.
(6) There will be required five corps laboratory equipments similar to those now used
in the cantonments established in the United States.
(c) Additional equipment which will be required for the army laboratory will be
covered by requisitions from France from time to time.
4. Resume:
(a) Required at once: 2 chemists, Sanitary Corps.
(6) Reqviired with each new division which may come to France: 2 officers (1 a chemist),
4 men (1 a chemist), 1 field laboratory equipment, to which there must be added 1 chest,
chemical (for the detection of mineral poisons, etc.).
(c) Required before November 15, 1917: 1 cantonment laboratory (4 others to follow
before January 15, 1918).
(d) The personnel for corps laboratories should be sent from time to time as indicated
by the divisions which are dispatched.
5. For the purpose of supply it is requested that this letter be taken as a requisition.
This letter indicates, among other things, that the chief surgeon's office
desired three special types of laboratories not previously authorized in War
Department Tables of Organization. A representative of one of these types, an
army laboratory, was already provided, so far as nomenclature was concerned,
in army laboratory No. 1, but in addition to its other services this unit operated
as the headquarters laboratory for the entire American Expeditionary Forces
until the central medical department laboratory was established at Dijon,
January 1, 1918.^ Thereafter in addition to serving the troops in the combat
zone, it also served the advance section.^ A second type of unit desired was the
corps laboratory, to be organized and dispatched to France in the proportion
of one for each corps.' The plans accepted at this time provided that each of
these units should be of a stationary character, and well equipped for the ser-
vice of corps troops, but events proved that their employment as contemplated
was not practicable.' Therefore, on arrival, the corps laboratories were diverted
from their original purpose and operated as base laboratories in the different
sections of the Services of Supply. The third type of special laboratory desired
was the field or divisional laboratory unit, one of which was to be provided for
each division. These units were to be supplied with the standard field labora-
tory equipment already authorized by the Medical Department. As the situ-
ation later developed, these divisional units were retained in the final plan of
organization, but their equipment was changed.'
In addition to the special types of laboratories mentioned above, Tables of
Organization already provided for a laboratory as a part of each base hospital
and specified its personnel and equipment.^ Though none of the corps or divi-
sional laboratories reached France before November 1, 1917, several base hos-
pital laboratories (Nos. 6, 101, 15, 18, 17, 8, 9, and 27) arrived and began
140
AD.MINISTKATION, AMERICAN EXPEDITIONARY FORCES
operating.^ These base hospital laboratories had fairly complete equipments
and supplies at this time, but much of it was useless, since neither sufficient
gas nor usable electric current was then obtainable.^
Before November 1, 1917, the personnel of the laboratory service in France
consisted, in addition to the staff of army laboratory No. 1, of two commissioned
officers and a varying number of enlisted technicians with the laboratory of
each base hospital then in France.^
A considerable amount of routine clinical pathology was performed during
this early period and an autopsy service of practical value conducted. The
bacteriologic work done at this time consisted mainly of a study of the organ-
isms concerned in the prevalent infections of the respiratory tract.^ The service
for conducting Wassermann reactions was begun in September, 1917. The
difficulties to be overcome were many. Little equipment was available, all
reagents had to be prepared and standardized, only with the greatest difficulty
could guinea pigs be secured, only a low-speed hand centrifuge was available,
and it was necessary to use some very primitive equipment.^ At that time it
was planned that the Wassermann work for the entire American Expeditionary
Forces would be done at army laboratory No. 1, but this proved impractical
because of delays in transmitting specimens and reports.^
In the latter part of October, 1917, a division charged with the supervision
of the laboratory service of the American Expeditionary Forces was created
as a part of the office of the chief surgeon, and Circular No. 2, chief surgeon's
office, dated November 9, 1917 (quoted in the appendix), which announced
the creation of professional divisions in that office, included among others the
division of laboratories. Later in the same month a section of infectious dis-
eases was added to this division.^
The chief surgeon on November 11, 1917, instructed the director of labora-
tories, A. E. F., to submit plans to organize a division of laboratories and infec-
tious diseases.^ Some information was then available concerning the organi-
zation of the laboratory services in the British and French Armies, but it seemed
advisable to plan for a somewhat more comprehensive organization with greater
centralization and more definite administrative control and coordination than
existed in those forces.^ The general projects of organization and phases of
development for the American Expeditionary Forces as worked out by the
general staff were reviewed, the plans of the hospitalization division of the office
of the chief surgeon, including geographic location of hospitals present and pro-
spective (i. e., those leased, under construction, or projected) were studied, and
as much relevant information as possible was obtained, concerning the proposed
lines of railway communication.^ By means of this information, and the
employment as a basis of the preliminary plans for the laboratory service
already adopted, a highly developed project for the organization of this divi-
sion was formulated.^ On December 29, 1917, a general outline of the pro-
posed organization was submitted to the chief surgeon, and on January 11,
1918, a detailed outline with the statement that plans were already being formu-
lated to effect a number of the features it prescribed.^ This latter project,
which was approved by the chief surgeon, was as follows : ^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 141
Activities — Division of Laboratories and Infectious Diseases
section of laboratories
1. Representative of chief surgeon in all matters relating to laboratory service.
2. General supervision of all laboratories and the assignment of special personnel.
3. Direct supervision of purchase and distribution of laboratory equipment and supplies.
4. Publication of circulars relating to standardization of technical methods, collection of
specimens and other matters of technical interest to the laboratorj^ service.
5. Collection and distribution of literature relating to practicable and definite advances
in laboratory methods.
6. General supervision of research.
7. Supervision and action on manuscripts of laboratorj- personnel to be presented to
chief surgeon for i)ubIication.
8. Cooperation and coordination with the directors of all the professional divisions, in
order that medical and surgical problems arising during the war may be most effectively
handled from the laboratory point of view.
SECTION OF INFECTIOUS DISEASES
1. Representative (advisory) of chief surgeon in matters relating to the prevention and
control of transmissible diseases.
2. Collection and distribution of hterature pertaining to practical advances in methods
of prevention and control.
3. Preparation of circulars relating to prevention and control.
4. Detail of specially trained units with personnel and mobile material, on request from
the division of sanitation, for the investigation of epidemics or threatened epidemics.
5. Experimental investigations of suggested prophylactic methods for the prevention of
infectious diseases and recommendations relative to their general adoption.
6. Collection of statistics and epidemiological data on infectious diseases.
A. CENTRAL ORGANIZATION
1. Central offices.
Personnel:
Director of division of laboratories and infectious diseases —
(a) Assistant director (section of laboratories) .
(b) Assistant director (section of infectious diseases) .
(c) Adjutant; 2 secretaries, 2 clerks, chauffeur and orderly.
2. Central medical department laboratory, A. E. F.
Divisions:
(a) Bacteriology.
(6) Serology.
(c) Pathological anatomy.
(d) Chemistry (sanitary — medical).
(e) Medical biology.
if) Supplies (diagnostic and therapeutic sera, vaccines, culture media, stains,
standard solutions, portable laboratory units, etc.).
Activites:
(a) Standardization of technical methods.
(6) Manufacture and distribution of culture media, stains, agglutinating
sera, amboceptor, antigen, etc.
(c) Distribution of diagnostic and therapeutic sera, vaccines, etc., to base,
camp hospital, army, evacuation hospital, and divisional laboratory
units and to troops.
(d) Supply of complete transportable and other mobile laboratories for
units in the field and for special investigations. (Meningitis, diph-
theria, pneumonia, enteric fevers, etc.)
(e) Supply of laboratory animals.
if) Special highly technical chemical and other laboratory work as required.
142
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Central medical department laboratorv, A. E. F. — ^Contimiod.
Divisions — Continued.
Activities — Continued.
(g) Standardization of technique and records of post-mortem examinations
and supervision of collection of museum specimens to be forwarded to
the Army Medical museum.
(h) Special work on insects (lice, etc.).
(i) Special research work.
(j) Instruction of laboratory personnel in technical methods (wound bac-
teriology, etc.).
(fc) Supply of special personnel and material for the investigation of epi-
demics.
Personnel :
Commissioned —
Commanding officer.
Adjutant.
Quartermaster.
Chief, division of bacteriology.
Assistant, division of bacteriology.
Chief, division of serology.
Assistant, division of serology.
Chief, division of pathological anatomy.
Chief, division of chemistry.
Chief, division of medical biology.
Enlisted and civilians (43) —
2 secretaries.
3 clerks.
10 technicians.
1 electrician.
1 plumber.
1 cabinetmaker.
1 general carpenter.
1 packer.
6 chauffeurs.
1 mechanic, having general knowledge of autos.
1 motor-cycle driver.
5 general utility men.
10 civilian laborers.
Note. — Both commissioned and enlisted personnel will be attached temporarily to
this laboratory from time to time, for purpose of instruction. Special mobile units for special
investigations and reinforcements will be held in reserve at this laboratory.
The central laboratory will supply culture media, stains, therapeutic sera, standard
solutions, and other expendable laboratory items to laboratory units in the intermediate and
advance section, line of communications, and the zone of the advance. It will equip, distri-
bute, and replenish the transportable laboratory units for camp hospital laboratories. It
will stock and replenish all transportable laboratories (in chests) for special investigations
(meningitis, pneumonia, diphtheria, typhoid, dysentery, etc.), and all motorized corps and
special mobile laboratories functioning in the intermediate and advance sections, line of
communications, and the zone of the advance. In the investigation and control of epidemics
and threatened epidemics, it is of the utmost importance that the existence of suspected
disease be recognized promptly, in order that measures for its control and prevention may
be instituted without delay. Experience has demonstrated already that railway transporta-
tion fails absolutely to meet the necessary requirements. All parts of the area served by the
central Medical Department laboratory can be reached by motor transportation in from two
to eight hours and an adequate motor transportation will be urgently required. The following
transportation will be necessary:
1 13^-ton truck.
2 light Ford trucks.
2 Ford ambulances.
1 passenger car closed (Dodge).
1 passenger car (Ford).
2 motor cycles with side cars.
6 motorized bacteriological laboratories (re-
serve) .
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 143
B. GENERAL ORGANIZATION"
(Division of Laboratories)
1. Base laboratories:
(These laboratories will be of two general types: Those functioning directly under
the headquarters of the different sections of the Services of Supply and those func-
tioning as base laboratories for single base hospitals or for groups of base hospitals.)
(1) Base laboratories, Services of Supply — -
Divisions —
(a) Bacteriolog}' .
(6) Serology.
(c) Pathological anatomy.
(d) Chemistry (sanitary and medical).
(e) Supplies (diagnostic and therapeutic sera, vaccines, culture
media, stains, standard solutions, etc.).
Activities —
(a) Manufacture of culture media.
(6) Distribution of culture media, stains, diagno.stic and therapeu-
tic sera, etc., to camp hospital laboratories and base labora-
tories, base hospitals, in their section.
(c) Stocking and replenishing special transportable and motorized
mobile units functioning in their section.
(d) Supply of laboratory animals,
(c) Special research.
(/) Investigation of epidemics and threatened epidemics in their
section by means of special personnel and material attached.
(Transportable units in chests for investigation meningitis,
diphtheria, pneumonia, dysentery, etc., and motorized bac-
teriological laboratory for special investigation.)
(g) Serological and special bacteriological work for camp hospitals,
base hospitals, and for troops.
Personnel — •
Commanding officer.
2 commissioned assistants permanently attached.
2 commissioned assistants to be available for special duty in
investigating epidemics.
The necessary enlisted and civilian personnel.
Transportation —
1 passenger car and 1 motor cycle with side car.
1 motorized bacteriological laboratory.
(2) Base laboratories, base hospitals —
(These laboratories will be organized for single base hospitals (1,000
beds) and base hospital groups (5,000 to 10,000 beds). They will be
well equipped as to personnel and material and capable of doing any
workjOrdinarih' carried on in a good laboratory.)
Activities —
(a) Bacteriological, serological and gross and histopathological
work for base hospitals or for groups of base hospitals.
(6) When necessary, they will be charged with the serological
and specialized bacteriological work for camp hospitals in their
vicinity.
(c) Supply of therapeutic sera, vaccines, etc.
Note. — The routine pathological work (blood counts, urines,
smears, etc.) in base hospital groups will be done by a special
personnel in small laboratories in close proximity to the wards.
Special base laboratory buildings with adequate space are being
provided for in the plans for the construction of groups of base
hospitals (5,000 to 10,000 beds).
Transportation — 1 motor cycle with side car.
13901—27 10
144
ADMINISTRATIOX, AMERICAN EXPEDITIONARY FORCES
Base laboratories — Continued.
(3) Camp hospital laboratories —
Activities —
(a) Routine clinical pathological work for camp hospitals (300
beds) and regimental infirmaries (urines, sputum, blood
counts, dark field, diphtheria cultures, etc.)
(b) Collection of specimens from regimental infirmaries (blood
for Wassermann, etc.) to be forwarded to base and army
laboratories.
(c) Distribution of reports to regimental infirmaries.
Personnel —
1 bacteriologist.
3 enlisted technicians.
1 motor-cycle driver.
Transportation — 1 motor cycle wuth side car.
Equipment — Transportable expandible units in chests.
(4) Evacuation hospital laboratories —
(These units will be assigned to evacuation hospitals and will have
the necessary equipment to do the routine clinical ward work and special
work in wound bacteriolog}^ for evacuation hospitals).
(5) Army laboratories —
(Stationary units. Located in permanent buildings in the zone of the
advance or in the advance section, line of communications, immobilized
well equipped. Directly under the chief surgeon, A. E. F., for adminis-
trative purposes. Designated as army laboratories but will not be
mobile in the sense of being attached to any particular army and follow-
ing it as it moves. These laboratories will be organized as necessity for
them arises and will be numbered serially.)
Activities — Similar to the activities of base laboratories.
Personnel —
4 commissioned.
10 enlisted.
Transportation — -
1 passenger car (closed).
1 Ford truck or ambulance.
1 motor cycle.
(6) Corps laboratories — -
These laboratories will be motorized, mobile units, completely equipped
for general bacteriological and epidemiological investigations. They will
be numbered serially. They will not be assigned definitely to corps
but will be attached to armies, corps, or other units when their services
are required. For administrative purposes and purposes of mobility,
they will be controlled directly by the chief surgeon.
Activities — Investigation of special problems, epidemics, reinforcement
of laboratory units in the zone of the advance, etc.
Personnel —
1 commissioned.
2 enlisted.
Transportation — ^1 motorized bacteriological laboratory.
(7) Division laboratories —
(These units will be assigned definitely to divisions and will be under
the order of the division surgeon.)
Activities — General routine pathological work for the division, includ-
ing bacteriological and chemical examinations of water supplies.
When the division is in training, the laboratory unit should be attached
to the camp hospital in its particular area. When serving at the
front, one bacteriologist and technical assistant will be detached for
service in wound bacteriology at evacuation hospitals or special
surgical units near the front.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 145
Base laboratories — Continued.
(7) Division laboratories — Continued.
Personnel —
1 medical officer.
1 officer, Sanitary Corps (water).
4 enlisted.
Transportation —
The portable laboratory is to be transported on the sanitary train
of the division.
1 motor cycle with side car.
Equipment — In chests, each chest containing a complete unit for
a definite purpose. Number of units assigned dependent on char-
acter of work anticipated. Ordinarily the equipment furnished will
meet the requirements for routine clinical examinations (chemical
and bacteriological), examinations of water supplies, and wound
bacteriology.
(8) Special units —
Motorized mobile units.
(a) Bacteriological cars.
(6) Meningitis cars.
Transportable mobile units (in chests) —
(a) Meningitis units.
(b) Diphtheria units.
(c) Pneumonia units.
(d) Typhoid group, dysentery units.
(e) Wound bacteriology units.
(/) Water supply units.
(g) General bacteriological units.
(h) Camp hospital laboratory units.
(i) Division laboratory units.
Note. — These special units will be assembled at the cen-
tral Medical Department laboratory and sent where required.
Their expendable supplies (culture media, stains, etc.) will
be replenished at the central and base laboratories.
In addition to the functions outlined in this plan, the division of laboratories
assumed certain others also; e. g., the collection of statistics on routine and
special work done in laboratories, cooperation and coordination with the Chemi-
cal Warfare Service, supervision of the collection of museum and photographic
records of the Medical Department, and research in a number of medical prob-
lems. Furthermore, additional sections later were added to the division, viz.,
that of food and nutrition, and that charged with supervision of purification of
water supplies.^
Some other modifications of this original plan also proved necessary, the
more important being the following: ^ Army laboratories of a stationary type
were not organized, and mobile units were assigned to the headquarters of field
armies for use in investigations of epidemic disease in the field; corps labora-
tories were not organized, for only exceptionally could highly specialized, tech-
nical, bacteriological work, such as wound bacteriology, be done in evacuation
and mobile hospitals during active military operations; the divisional laboratory
units usually were unable to function, from the purely laboratory point of view,
during combat, and furthermore they required additional equipment when in
rest or training areas. ^
146
ADMTXT8TRATK)X, AMERICAN' f:XPKI)ITr()XAHV FORCES
However, after the chief surgeon's approval of tlie phiii detailed above,
efforts were immediately begun by the director of laboratories to carry it into
effect, the organization of the laboratory section and more particularly the
establishment of a central (headquarters) laboratory being given first considera-
tion.^ After a thorough study of the projected line of communications it was
decided that the central laboratory should be located at Dijon, which situation
presented many natural advantages. The chief reason for selection of this
locality was its proximity to the American front and training areas and to
the main line of communications.^ On a visit of inspection to that city by
the director of laboratories on December 15, 1917, a modern laboratory building
was found which constituted a part of the plant belonging to the University of
Dijon. Late in the same month arrangements were completed for taking over
this structure and here the central Medical Department laboratory was estab-
lished on January 1,1918.^ On the same date the director of laboratories moved
his office to the same point from Neufchateau, where it had been located first
in the office of the commanding officer of Army laboratory No. 1, and then in a
hut erected beside the laboratory.^
At Dijon the director's office was first established in the central Medical
Department laboratory, but in April, 1918, a temporary wooden office building
100 feet long and 20 feet wide, located on the grounds of the laboratory, was
completed and occupied by the director.^
The preliminary plans for the office provided that only two-thirds of the
building would be used for office purposes, the remainder being reserved for
storage and expansion if necessary, but even before this plan could be applied
the volume of work had so greatly increased that the entire building was arranged
for office purposes. One large room served as a combined office and library,
partitions dividing the remainder into small offices with connecting doors. ^
The structure was well lighted by electricity and was heated by stoves during
the winter months; telephone connections through a local switchboard provided
communication both with local and distant offices. Eventually satisfactory
telephone connections could be made with places as far distant as Bordeaux,
St. Nazaire, and Brest. ^ The director's office remained in this building until it
was transferred to the office of the chief surgeon at Tours in June, 1919.^
The general arrangement of the offices and the relationship of the office
buildings to the central Medical Department laboratory are shown in Figure 5.
Until February the director's office force was still limited to one stenographer,
but efficient office and other personnel was then procured, adequate to require-
ments.^
On February 6, 1918, the director of laboratories w^as directed to make
such journeys as were necessary in matters pertaining to the service of that
specialty.^ Prior to January the urgent necessity for completion of plans for
the organization of this division had been such that but little time could be
devoted to inspections.^
During the period from August to December, 1917, inclusive, the plans of
organization of the division were elaborated, definitely formulated and adopted;
from January to June, 1918, inclusive, the laboratory service underwent active
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 147
development; from July to Novembei', 1918, inclusive, it worked under stress;
and from December, 1918 to July, 1919, inclusive it underwent demobilization.^
In the spring and early summer of 1918, a considerable number of addi-
tional activities were assigned to the division and new sections were established
as mentioned above. ^
On May 22, 1918, the director of laboratories forwarded to the chief
surgeon the following letter,* which gave a general summary of organization
then effected and projected, and especially stressed the transportation needs
of the laboratory service.* Such needs became of very urgient importance
later. ^
Rut L'LGAUITE.
Fig. 5.— Ground plan, headquarters, division of laboratories, A. E. F., and central Medical Department laboratory, Dijon
1. I am inclosing herewith a table of organization for laboratory units that this office
considers necessary for the American Expeditionary Forces; as will be noted the laboratories
are divided into two basic types: Stationary and transportable.
STATIONARY LABORATORIES
2. Central Medical Department laboratory. — This laboratory is situated in the advance
section and is thoroughly equipped to do anj' work that ma,y come up. It is estimated that
it will eventually recjuire 25 officers and 50 enlisted men. So far as is possible we are cutting
down the enlisted personnel by the employment of civilian technicians and laboratory assist-
ants, thus releasing male personnel for more urgent field duties. The civilian personnel
is quite satisfactory and is in reality cheaper than enlisted personnel.
This laboratory, in addition to its permanent personnel, has established laboratories
equipped for special investigations. At the present time surgical shock and chest surgery
are the subjects of special investigation in special laboratories. The water-supply service,
A. E. F., is provided with special laboratories here. We have arranged with the intelligence
section, general staff, to organize a special chemical section here for the investigation of
148
ADMINISTRATIOX, AMEKICAX EXPEDITIONARY FORCES
correspondence and the development of invisible inks. Special problems will come up from
time to time and this laboratory will be prepared to handle them.
Referring to transportation required for this particular laboratory, it will be necessary
to send laboratory personnel out from this center to various parts of the Advance Section
and Zone of Advance for investigation of epidemic diseases. The motor cars, light, are
required for this particular purpose. It will also be necessary to deliver standardized
laboratory units and replenishment supplies to mobile units in the zone of advance, and three
motor trucks, medium, and three motor trucks, light, will be required to meet these needs.
We have adopted a standard expandable laboratory unit system in chests with the idea
that when a special investigation of epidemic diseases is to be undertaken, one of these
transportable laboratory outfits can be placed on a motor truck, medium, size \}/2 tons capac-
ity, proceed to the area to be investigated, unpack the chests and organize the laboratory
in a vacant room. On completion of work of this character the laboratory can be repacked
within an hour's time and returned to its station with its own transportation.
Laboratorj^ supplies and sera of various kinds will be required in the front areas, and
these can be taken care of (when railroad facilities are not direct or possible) by the light
motor trucks and by motor cycle with side car. The two bicycles can be used for messenger
work in the city. This laboratory has at the present time three bacteriological cars, motor,
and these cars will be used for investigation of special epidemics.
3. Base laboratories, sections Services of Supply. — Base laboratories are being organized
in each of the sections on the lines of communication. Already one has been established
Fig. 6.— Floor phm of the office of the director, division of laboratories, A. E. F.
for base section No. 1, base section No. 2, and intermediate section. Services of Supply,
and stationary laboratories are now en route from the United States for base section No. 3
and base section No. 5. These laboratories will handle the general laboratory work and
laboratory work concerned with the prevention of infectious diseases in their respective
sections. To carry out this work efficiently and effectively, transportation will be neces-
sary. One light motor car, passenger, is asked for; one motor cycle with side car; one
bicycle; and one motor truck, medium. To each of these laboratories one transportable
laboratory outfit will be supplied and one 13^-ton motor truck will be required to transport
this laboratory from place to place for the investigation of epidemics.
4. Base hospital laboratories at base hospital centers. — We have organized at each base
hospital center one laboratory well provided as to personnel and equipment. This laboratory
will serve as a central laboratory for the entire group of hospitals, and in this laboratory
it is proposed that all highly technical bacteriological and serological work will be done. In
addition to this it is the intention to establish a certain number of small clinical ward labora-
tories in connection with a certain number of wards. By carrying out this arrangement
we will conserve building space, equipment and personnel. The only transportation neces-
sary for such a unit is a motor cycle with side car and one bicycle.
5. Base hospital laboratories at base hospitals. — These laboratories will be provided for
base hospitals of from 1,000 to 1,500 beds. No transportation will be required for such units.
6. Army laboratories. — We are organizing in the advance section, or zone of the advance,
laboratory units that will be of a fixed character and will be known as Armv laboratories.
These laboratories will be so located that they will be closely in touch with troops in the line,
and it is proposed that all highly technical bacteriological and serological work for divisions
in the field be done by these units. They will also be provided with a transportable labora-
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 149
tory unit for the investigation of epidemics and will care for epidemics in their particular
section. In order to carr\- out work on epidemics eflfectively, it will be necessar\- to supply
them with a IJ^-ton motor truck for the transportation of the transportable laboratorj-.
TRANSPORTABLE OR MOBILE UNITS
7. Camp hospital laboratories. — We have arranged to supply camp hospitals with trans-
portable units in chests, but as these units are permanent or semipermanent, no transporta-
tion for carrying their transportable units will be necessary. They should be provided,
however, with a motor cycle with side car, in order that they may be in close touch with
infirmaries and other units for which special work will be done.
8. Evacuation hospital laboratories. — These units are made up of the standard transportable
outfits and consists of eight chests. They should be provided with a 13^-ton motor truck
to carry their equipment. This truck will be used constantly by the pathological and museum
units attached to the laboratory of evacuation hospitals when not in use.
9. Mobile hospital laboratories. — A transportable laboratory unit consisting of eight
chests is required for each mobile hospital, and in order that it may be transported one truck,
motor, medium, will be required.
10. Divisional laboratories. — This laboratory unit is attached to each division, and its
equipment consists of three of the chests of the standardized transportable outfits. To make
this unit mobile it will be necessary to supply one light motor truck capable of carrying these
three chests. This unit will also require one motor cycle with side car.
11. In connection with the transportation provided for in this T. of O., this office is con-
vinced that the laboratory service will not and can not perform its functions properly unless
provided with transportation. In working out the organization of supplies for mobile and
semimobile units, we have endeavored to standardize equipments, and this has been accom-
plished by providing an expandable unit laboratory system in chests. These chests are so
arranged that a given number of chests will care for the work of camp hospitals and divi-
sions, while the evacuation hospitals and mobile hospitals will require the full number —
eight. The British system has been somewhat different. They have organized a unit
system consisting of a bacteriological motor car, with the idea that the necessary work
would be done in this car. As a matter of practice it has been found that usually the equip-
ment would be taken out of the car and placed in a vacant room provided the unit remained
at one place for any great length of time. These cars cost approximately $7,000. We feel
that the system adopted by us will be more satisfactory and will be much cheaper, provided
the necessary transportation is furnished. A standardized laboratory unit of chests costs,
complete, about $1,200, and a motor truck of IJ^-ton capacity will probably cost in the
neighborhood of $2,000. This makes about $3,500, while the British units cost from $6,000
to $7,000.
12. It will be necessary that the truck transportation allowed for these mobile units be
assigned very definitely to these particular laboratory units; otherwise they lose their mobiUty.
Laboratory suppUes are difficult to secure. We have heard that during a recent German
offensive on the Western Front the laboratory service for the British Army in France were
able to save their entire equipment. This was possible by reason of the fact that they had
transportation definitely assigned to them.
J. F. SiLER,
Lieutenant Colonel, Medical Corps, United States Army.
As mentioned above, the division of laboratories had been incUided among
the professional services prescribed in Circular No. 2, chief surgeon's office, A. E.
F., November 9, 1917.^ But that division, being a part of the division of sanita-
tion in the chief surgeon's office, and therefore in a somewhat different adminis-
trative position from the other professional services which were under control
of the hospitalization division, was not grouped with these when they were
reorganized by Circular No. 25, chief surgeon's office, A. E. F., May 5, 1918,
and by General Orders, No. 88, G. H. Q.. A. E. F., June 6, 1918.
150
ADMIXISTRATIOX, A:\IER1CAN EXPEDITIONARY FORCES
The director of the division of hiboratories enjoyed entire freedom in tlie
organization and development of his department except that all matters of policy
and those affecting the service in general were submitted to the chief of the
division of sanitation for final decision.^ The director was authorized to issue
circulars, memoranda, and special letters of instructions concerning matters of
interest in the laboratory service. Memoranda which were of interest to the
Medical Department at large were submitted to the chief surgeon and issued as
circulars from his office.^
At the time the office of the director of the division was established at Dijon,
that of the chief surgeon was located at Chaumont, and because of their proxim-
ity there were then no great difficulties of coordination. But after the chief
surgeon's office was transferred to Tours, in March, 1918, the unavoidable con-
gestion of telegraph and telephone lines, necessary censorship regulations, and
irregular mail facilities often caused considerable delay in receipt of orders
affecting transfer of personnel.^ This situation was remedied by granting to
the director of the division in August, 1918, authority to issue suitable orders
to personnel under his control whereby he could meet emergencies and fill
existing vacancies from the reserve staff on duty at the central medical depart-
ment laboratory.^ Thereafter the efficiency of the laboratory service was
greatly increased, particularly by promoting both the early investigation of
epidemic diseases and quick response to emergencies that developed during
combat. Better coordination would have been secured if the director's office
had been located in the office of the chief surgeon, for delays which occurred at
time in communication would have been obviated.^ But many and greater
office advantages accrued from maintenance of close contact between the direc-
tor's and the central Medical Department laboratory at Dijon.^ The labora-
tory was so located that it was less than six hours distant from 1,500,000 troops
and from hospitals with a total capacity of more than 100,000 beds. Request
was made of the hospitalization division of the chief surgeon's office that the direc-
tor be promptly apprised of the arrival and location of all hospital units arriving
overseas.^
GENERAL CORRELATION AND ACTIVITIES
In order to correlate the work of the division with the activities of the
Medical Department in general, the following, methods were employed:^
Letters covering the progress of the work and plans for the future were
written at frequent intervals to the chief of the division of laboratories in the
office of the Surgeon General at Washington, and in July, 1918, an officer was
sent to Washington in order to give more definite information concerning the
various problems confronting the laboratory service of the American Expedi-
tionary Forces.^
The director had frequent conferences with the head of the division of
sanitation in the chief surgeon's office, the progress of the work being reviewed
and special matters brought up for final action.^
Weekly reports, covering the general activities of the division were sub-
mitted to the chief surgeon and copies forw^arded to the Surgeon General.^
Copies of all reports on investigations of epidemics as well as reports that
were considered of sufficient interest were transmitted to the chief surgeon for
his information.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 151
When general or technical circulars involving action by some other divi-
sion or service were contemplated, that division or service was consulted, and
approval and cooperation secured before the circular was published.
A special mailing list was prepared, including divisions of the chief sur-
geon's office, the professional divisions, the sanitary school, the Pasteur Insti-
tute, the adviser in pathology to the British Expeditionary Force, the secretary
of the British research committee, the secretary of the research committee of the
American Red Cross, and individual officers on duty with the American Army,
the French Army, the British Army, and the Italian Army, to all of whom
special memoranda, etc., were forwarded.^
Officers of the division represented it at the meetings of the Inter- Allied
Surgical Congress.^ The director of the division attended sessions of the
research committee organized by the American Red Cross, of which committee
he was a member.^
Matters affecting the medical and surgical services were taken up through
liaison officers appointed for this purpose by the chiefs of those services. These
matters, in so far as the medical service was concerned, included, among others,
control of epidemic diseases.^
All matters relating to water supplies were taken up with the senior repre-
sentative of the Medical Department with the w^ater supply service, A. E. F.^
In the summer of 1918, it was planned to initiate conferences of special
groups of officers at stated intervals for the purpose of discussing special features
of their work and the local problems with which they had to contend.^ These
meetings were to be held every month or six weeks, at the central Medical
Department laboratory, and were to be limited to groups of officers engaged
in identical lines of work.^ One meeting was to include the commanding officers
of base laboratories operating in the different sections of the Services of Supply,
and the officers engaged in disease control; one was to include the commanding
officers of base laboratories in hospital centers; another the laboratory officers of
evacuation and mobile hospitals; another the officers in charge of division labora-
tories, etc.^ But because of combat activities it was not possible to call the first
conference until November 1 and 2, 1918.^ This was attended by the chief of
the division of sanitation, chief surgeon's office and his assistant, by the com-
manding officers of the base laboratories functioning in the sections of the Ser-
vices of Supply, by sanitary inspectors of the sections of the Services of Supply,
and others.^
After the signing of the armistice, conditions became so unsettled that it
was not practicable to continue these conferences.^
DIRECTOR'S OFFICE
ADMINISTRATIVE DETAILS
For administrative purposes the office of the director, division of laborato-
ries and infectious diseases, was divided into six general sections with one or
more officers on duty in each as assistants to the director. These sections were :
(1) Executive office and records, (2) central Medical Department laboratory,
(3) section of laboratories, (4) section of infectious diseases, (5) food and
nutrition section, and (6) water supply section.^
152
ADMINISTRATION, a:MERICAN EXPEDITIONARY FORCES
The offices of the director and those of the chiefs of all the sections were
located in the same building except that the commanding ollicer of the central
Medical Department laboratory had his office in an adjoining structure.'
While the ensuing text attempts, for the purpose of clarity, to discuss
separately the several sections of the division of laboratories and infectious
diseases, there was such close coordination and overlapping of several of these
that note should be made of that fact.' Certain officers on duty at headquarters
of this division at Dijon were also on the stafT of the central laboratory or on
that of the laboratory section.' The central laboratory while a part of the
general laboratory system, was highly individualized, and from an administra-
tive point of view was difierentiated from the section of laboratories in this
division, but the activities of the latter were often supplemented by those of
the former, as in the solution of special problems and in other matters noted
below.'
The records pertaining to all sections of the office of the director, except
autopsy protocols and statistical reports, were centralized in a single file, con-
trolled by the same decimal filing system which was in use throughout the
Army.' Incoming mail was classified by the adjutant and distributed directly
to the officers concerned. Reports and documents of general interest went
first to the desk of the director and were then circulated in the office before
going to file.' Correspondence and other matters requiring routine action
were acted on by the officer directly concerned and only such matters were
brought to the attention of the director as were considered to be of interest to
him, or concerning which his decision was required.'
Matters of general policy were taken up by the director with the officer or
officers directly concerned and if considered desirable, with all members of the
staff who might have special knowledge of the subject or from whom advice
would be of value.'
Special memoranda, circulars and forms were prepared ordinarily by the
section most directly concerned, but those of special importance were reviewed
by several members of the staff. These memoranda and circulars were of two
general types: Those covering subjects of general interest to the entire Medical
Department, and those covering technical matters pertaining to the laboratory
service.' The former were forwarded to the chief surgeon for incorporation
in official circulars issued by his office, while the latter were issued and distri-
buted directly from the office of the director as "office letters," "memoranda,"
or "forms," those in each class being given serial numbers.' A general idea
of the material forming the subject matter of circulars and memoranda may
be gained from the lists given in the appendix.
The commissioned personnel of the division of laboratories was distributed
and assigned mainly by the officer at the head of the laboratory section, with
suggestions, in some instances, from the director.' The distribution of the
special personnel on duty in the sections of food and nutrition, of water supply,
and of infectious diseases were assigned on the recommendation of the officer
in charge of those sections, respectively.'
The personnel of this division consisted of officers of the Medical Corps
with special training in laboratory procedures, sanitation, and epidemiology, or
ORGANIZATION AND ADMIXISTEATION OF CHIEF SURGEON'S OFFICE 153
other special qualifications; officers of the Sanitary Corps who were sanitary
engineers, had special knowledge of food and nutritional problems, were com-
petent to make field surveys and laboratory examinations of water supplies,
had general or special qualifications in laboratory procedure, were artists,
photographers, executives, or possessed other special qualifications; and enlisted
men, many of whom had a special technical training.^
Not more than 12 officers of the Regular Medical Corps and of the Sani-
tary Corps, who served with the division of laboratories, had any service in
the Army prior to the war.^ Two of these medical officers and one officer of
the Sanitary Corps were on duty in the office of the director, the others being
assigned to laboratory administrative positions elsewhere in the American
Expeditionary Forces.^ The remaining personnel, consisting of approximately
670 officers, was drawn chiefly from civil laboratories.^ Many of the enlisted
personnel were college graduates, undergraduate students, or men with special
technical training in laboratory work of various kinds. As with the Medical
Department generally, there was always a shortage both of total personnel
and of those competently trained.^
The personnel to carry on the activities of the division of laboratories was
acquired from various sources, mainly the following: ^ (1) Base hospitals and
a considerable number of evacuation hospitals, for the prescribed organization
of both those types of units included laboratory personnel; (2) stationary
laboratory units, of which 5 were sent to France, each consisting of 6 officers
and 12 enlisted men; (3) special units sent to France for special, highly tech-
nical activities; (4) divisional laboratory imits automatically dispatched to
France for service with divisions; (5) detachments of casuals sent to France
on cable requests from general headquarters. (6) The general medical serv-
ice of the American Expeditionary Forces whence a considerable number of
specially trained officers were drawn and assigned to duty with this division.^
All casual personnel and special units arriving in France for service in
this division were automatically ordered to the central medical department
laboratory, where their special qualifications were investigated and any neces-
sary special instruction given. ^
The individual qualification cards of officers of the Medical Department
on file in the headquarters office of the division permitted a broad general
classification of qualifications, but for the highly technical activities in which
the division of laboratories was engaged it was necessary to have a much fuller
knowledge of the special qualifications of each officer.^ A questionnaire,
covering in detail the information desired, was therefore filled in by each
officer on duty in the division of laboratories and filed in the office of the direc-
tor.^ A still better conception of the special qualifications of the individuals
was gained by direct observation of from 300 to 400 of these officers who served
on temporary duty at the central Medical Department laboratory either as
casuals or as students, taking courses of instruction.^ These officers were
interviewed by the personnel officer on duty in the office of the director of the
division, and ratings of those undergoing instruction were submitted to him.
From these sources of information and from inspections of the work being
done in the different laboratories an effort was made so to classify and dis-
154
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tribute the personnel that the necessary activities might be more efficiently
performed and elimination of the incompetent effected.^ The laboratory
personnel sent to France with the earlier base hospitals was made up, as a rule,
of highly trained and competent men. This statement also applies to many
of the special units.^ The special laboratory training of a considerable percent-
age of the officers, however, consisted only of the training ordinarily acquired
in medical schools plus a short course of training at the Army Medical School,
at the Yale Army Medical School, at the Rockefeller Institute, or at more
than one of these institutions.^ Therefore, special courses of instruction in the
bacteriology of epidemic diseases and in the bacteriology of war wounds were
given at the central Medical Department laboratory, approximateh^ 250 officers
taking one or the other of these courses.^ Because of the scarcity of trained
administrative personnel it was not practicable to form two detachments, one
consisting of casuals under the administrative control of the director's office,
and the other of permanent personnel assigned to the central Medical Depart-
ment laboratory.^ Therefore, both permanent personnel and casuals were
carried on the records of the detachment at the central Medical Department
laboratory as of a duty status, for rations, quarters, personal equipment and
for statistical and other matters pertaining to the interior administration of a
detachment.^ A list of the permanent personnel on duty at the central Aledical
Department laboratory was kept by the adjutant in the director's office. It
was understood that all other personnel was to be considered as casual and
subject to assignment by the director without previous consultation with the
commanding officer, central Medical Department laboratory.' After investi-
gation of their qualifications and any necessary special instruction, officers of
this division were assigned to appropriate stations.'
The division of laboratories was charged with the organization of new
laboratory units and the distribution of personnel under its supervision. All
requests forlaboratory personnel were referred to it, and assignments and changes
in station made on recommendation of the director.^
While in May, 1918, less than 140 commissioned officers were engaged in
activities under the supervision of this division, by November, 1918, this number
had increased to 683.^ Their distribution, by corps, grade, and general duties,
is shown in the following table : ^
Personnel on duty in division of laboratories and infectious diseases in November, 1918
Colonels
Lieu-
tenant
colonels
Majors
Captains
First
lieu-
tenants
Second
lieu-
tenants
Totals
Section of laboratories and infectious diseases:
Medical Corps
1
10
20
124
317
472
Sanitary Corps
2
6
64
76
148
Sectionof food and nutrition: Sanitary Corps
4
11
15
2
32
Section of water supplies: Sanitary Corps
1
5
15
10
31
1
11
26
146
411
88
683
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 155
PERSONNEL"
Col. Joseph F. Siler, M. C, chief.
SECTION OF LABORATORIES
Col. George B. Foster, jr., M. C, chief.
Lieut. Col. William J. Elser, M. C.
Maj. Ward J. McNeal, M. C.
SECTION OF INFECTIOUS DISEASES
Col. Richard P. Strong, M. C, chief.
Col. Hans. Zinsser, M. C, chief.
Maj. W^ard J. McNeal, M. C, chief.
Maj. Richard M. Taylor, M. C, chief.
SECTION OF WOUND BACTERIOLOGY
Lieut. Col. William J. Elser, M. C, chief.
Maj. Benjamin Jablons, M. C.
SECTION OF WATER SUPPLIES
Maj. Harry B. Hommon, San. Corps, chief.
Capt. Machael J. Blew, San. Corps.
Capt. Alvin R. Harnes, San. Corps.
Capt. Walter C. Russell, San. Corps.
Capt. Emery J. Theriault, San. Corps.
First Lieut. Henri E. St. Pieri'e, San. Corps.
SECTION OF FOOD AND NUTRITION
Maj. Walter H. Eddy, San Corps, chief.
Maj. Phillip A. Shaffer, San. Corps, chief.
Maj. David Klein, San. Corps.
Capt. Fred F. Flanders, San. Corps.
First Lieut. S. C. Dinsmore, San. Corps.
MUSEUM AND ART SECTION
Col. Louis B. Wilson, M. C, chief.
Maj. Henry W. Cattell, M. C.
LABORATORY OF SURGICAL RESEARCH
Lieut. Col. W^alter. Cannon, M. C, chief.
Lieut. Col. J. L. Yates, M. C.
" In this list have been included the names of those who at one time or another were assigned to the division daring
the period July 28, 1917, to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names have
been arrangc<i alphabetically, by grades, irrespective of chronological sequence of service.
156 ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
REFERENCES
(1) Report from Col. J. F. Siler, M. C, director of laboratories and infectious diseases,
A. E. F., to the chief surgeon, A. E. F., undated. Subject: Activities of division of
laboratories and infectious diseases, from August, 1917, to July, 1919. On file, Histor-
ical Division, S. G. O.
(2) Letter from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, August 12,
1917. Subject: Outline of laboratory organization, A. E. F. On file. Record Room,
S. G. O., 322.15-16 (A. E. F.) (Y).
(3) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919. On
file, Historical Division, S. G. O.
(4) Letter from Lieut. Col. J. F. Siler, M. C, director of laboratories, A. E. F., to the chief
surgeon, A. E. F., May 22, 1918. Subject: Table of organization for laboratory units.
On file, A. G. O., World War Division, chief surgeon's files, 451.
CHAPTER X
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
THE CENTRAL MEDICAL DEPARTMENT LABORATORY
HOUSING FACILITIES
A building, loaned for the purpose b}^ the University of Dijon, was utilized
by the central laboratory, established at Dijon on January 1, 1918. When
taken over the building was not equipped but early in February it was recon-
Fi(7. 7.— Central Medical Department laboratory, Dijon. The main building is in the center of the background
structed as a modern laboratory and completely equipped with material brought
from the United States for work of general and special character.^
By March, 1918, the buildings consisted of the initial large laboratory
structure, four barracks donated by the American Red Cross which housed
the office of the director of laboratories, a large laboratory for instruction of
student officers, five well-equipped research laboratories, an operating room
for experimental surgical research on animals, a complete X-ray installation
with photographic dark room, space for the art and museum section, and mess-
ing facilities and quarters for the enlisted personnel.^ Fixtures for gas, water,
and electricity, a very complete plumbing and sewerage system, and equipment
157
158
ADMIXISTKATIOX, AMERICAN EXPEDITIOXAKV FORCES
for general and special laboratory activities were installed in tiie i)iiildings
used for laboratory purposes. Later, four small Abincourt barracks were
added to provide animal houses and a carpenter shop, and four additional bar-
racks were erected for accommodation of enlisted personnel and storage of sup-
plies.^ The laboratory also secured two buildings for garage space and operated
a breeding farm for laboratory animals, on funds privately donated for special
research. The entire plant eventually occupied 18 large and small buildings.'
PERSONNEL
When established at Dijon, the central laboratory was staffed by officers
from Army Laboratory No. 1, at Neufchateau. By March, 1918, the staff
consisted of 16 officers, 35 enlisted men, and 12 civilian employees.' The
average personnel on duty at the central laboratory between June and Novem-
ber, 1918, was 24 officers, 93 enlisted men, and 23 civilian employees. From
November, 1918, to May, 1919, the average personnel remained approxi-
mately the same.'
LABORATORY EQUIPMENT AND SUPPLIES
One of the greatest difficulties that confronted the laboratory service in the
early months of the war w^as a shortage of equipment and supplies.' Before
the war many essential technical items, notably of apparatus, glassware, dyes,
and chemicals, had been imported from Germany. American industries that
had begun to manufacture these articles were still lacking in quantity production
in many essentials.' Furthermore, the normal peace-time stocks of dealers in
scientific apparatus and supplies were just sufficient to meet the comparatively
meger demands for the upkeep of established institutions and the initial equip-
ment of an occasional new one.' Demands such as were made by the Army in
the earlier months of the war were unheard of and they could not be met until
American scientific industries became organized for quantity production. The
situation was further complicated by priority schedules on raw materials, many
chemicals, and skilled labor, which diverted these to other war industries; and
a priority on shipping and tonnage that made the floating of supplies secondary
to the transportation of troops. The congestion at base ports, American Expe-
ditionary Forces, and shortage of transportation in France militated against
prompt handling of supplies after their arrival in France.'
With the exception of the initial equipment of three of the larger laboratories
and the laboratory equipment of a few base hospitals, laboratory supplies from
the United States were not available for issue in appreciable quantities until
about a month before the armistice. Furthermore, laboratory supplies in large
quantities were never available by purchase by us in France.'
When it became apparent that months would elapse before the automatic
supply of apparatus from the United States w^ould become available, an attempt
was made to reduce equipment and supplies to the absolute minimum consist-
ent with efficiency, and to standardize the equipment of laboratory field units. -
On August 19, 1917, an order for two motor bacteriological laboratories,
each to consist of a small but well-equipped outfit mounted on a 3-ton
chassis, was placed with a British manufacturing firm. This order contem-
plated the first use of such a unit in our service and was frankly experimental.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 159
The supply division of the chief surgeon's office, A. E. F., had made provision
for the shipment from the United States of such laboratory supplies as appeared
on the supply table of the Manual for the Medical Department, 1916, but this
list included only 84 items, which were quite inadequate to meet even the sim-
plest requirements.^ To meet the existing emergency, such supplies as were
available were purchased in France and contracts made by the supply division
for the continuous supply by French manufacturers of certain bulky items
requiring a very considerable amount of cargo space. ^ In coordination with the
supply division of the chief surgeon's office, requisitions were prepared covering
estimated future requirements with a view to their inclusion among supplies
shipped automatically from the United States.^ The shipment of laboratory
equipment according to this revised list did not begin until April, 1918, and did
not become available for issue in France in quantity until October, 1918.^
On January 12, 1918, the director was authorized to place direct with the
purchasing agent for the Medical Department in Paris, orders for the pur-
chase of standard laboratory equipment and supplies, except in the case of
special supplies desired in large quantity, or when the expense involved was
large. ^ Requisitions were also placed in England and some supplies obtained
from the American Red Cross. ^
In the detailed plan for the organization of the division of laboratories sub-
mitted to the chief surgeon, A. E. F., on January 11, 1918, the director of that
division recommended that special motorized and transportable units be pro-
vided.^ The motorized units were to be installed in their own cars while the
transportable units, packed in chests, were to be moved by any transportation
available.^ This plan, which was approved, provided for motorized laboratories
of two classes: Bacteriological cars and meningitis cars.'^
On the same date the director of laboratories wrote that several completely
equipped motorized laboratories were urgently needed.^ The next day the
chief surgeon, A. E. F., authorized the purchase of a "cerebrospinal" bacteri-
ological car to cost £1,892, exclusive of the chassis,* and on January 14 he
authorized the purchase from the French Medical Department of one motor-
ized bacteriological laboratory to cost approximately $8,000.^
In order both to conserve and standardize the equipment of field units,
the commanding officer of the central Medical Department laboratory under-
took to design a transportable laboratory in which the necessary equipment
and supplies would be reduced to approximately 150 items. ^ These items
were to be packed in eight chests so designed as to be capable of expansion in
numerous ways if necessary, to meet the essential needs of any type of labora-
tory. The selection of equipment for a set of these chests which would consti-
tute a division laboratory, also was undertaken.^
In reply to a query from chief of staff, G. H. Q., A. E. F., concerning
transportation which the division of laboratories would require, the chief sur-
geon replied, on February 4, 1918, in part, as follows: * "The increase of the
forces and the prevalence of epidemics would require that the laboratory
service be furnished among other vehicles with 6 motor trucks and 10 special
bacteriological cars." On February 11, the chief surgeon initiated a cable-
13901—27 11
160
ADMINISTRATION, A:MERICAN EXPEDITIONARY FOH(-KS
gram to the War Department asking that personnel reciuested lor divisional
laboratories be sent in accordance with the priority schedule, but that portable
field laboratories be substituted for laboratory cars.* On March 1, 1918, the
director, division of laboratories, reported that two motorized laboratories
each mounted on a 3-ton chassis were en route from England, but that it was
anticipated that eight more of these outfits would eventually be required.'"
"While most movable laboratories were to be of the type which utilized chests,
it was planned that a relatively small number of motorized laboratories
would also be employed. Under this plan the equipment for a divisional
laboratory would be contained in a set of three chests and a ^-ton truck
would be required for its movement. The laboratory for an evacuation or
mobile hospital would consist of a complete set of eight chests transportable
on a 13^-ton truck. ^' '• "
Toward the end of March, 1918, the commanding officer of the central
laboratory visited England with a view of determining the possibility of pur-
chasing laboratory material to equip the series of chests which he had devised,
and other assemblages of material.^
On April 29, he telegraphed the chief surgeon, requesting him to authorize
the purchasing officer of the American Expeditionary Forces in London to
purchase 100 transportable laboratory units at approximately $1,000 each.
The average cost of the truck on which one complete set could be transported,
he added, would be $3,400.'^ The chief surgeon complied with this request.^
Deliveries of the units which began on May 8, were completed October 24,
1918, so each division and each mobile or evacuation hospital which arrived
in France after the former date, was given its equipment before it entered the
advance zone.^ Such transportable laboratory units, attached to mobile and
evacuation hospitals, were equipped adequately for the performance of all
types of clinical and bacteriological work. Those attached to divisions were
equipped for the chemical and bacteriological examination of water supplies,
the performance of routine clinical examinations and the bacteriological exami-
nations necessary for the control of epidemics.^ This transportable equipment
was also utilized with very satisfactory results in many camp and base hospi-
tals, and in some hospital centers and base laboratories, pending the arrival
of the equipment for stationary units. ^
As noted in the preceding chapter, on May 2, 1918, the director of labora-
tories submitted a complete schedule of the transportation which would be
required by the division of laboratories and requested that this be furnished.
He also asked that motor cycles with side cars be issued to the laboratories
assigned to divisions, for these vehicles already had facilitated collection of
water samples and the prosecution of investigations in outbreaks of infectious
diseases.'^ This transportaion schedule in so far as it pertained to movable
laboratories was approved by the chief surgeon and was forwarded by him
for approval to the general staff, general headquarters,'* but despite repeated
subsequent requests, approved hj the chief surgeon, transportation for the
laboratory units in question was procured with the greatest diflficulty and only
to a partial degree with the results noted below in the consideration of
divisional laboratories.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 161
On July 8, the director of laboratories reported to the chief surgeon, A. E. F.,
that the earlier divisions arriving overseas had brought with them their labora-
tory personnel and equipment, that since that time it had been learned that
equipment could be simplified and that tonnage requirements could be reduced
by the purchase of all the materials required in England, but that field trans-
portation was essential if these units were to be of value. Similarly, on the
16th of the same month, he reported that the laboratories with mobile and
evacuation hospitals had already rendered invaluable service, but that neither
the laboratories of the hospitals mentioned nor those of divisions could function
properly without transportation, and he urged its provision. Other pleas and
arguments for transportation were forwarded, but because of the general short-
age of transportation throughout the American Expeditionary Forces, they were
only partially successful.'^
Because of the considerations mentioned in the letter of May 22, 1918, quoted
in the preceding chapter, and the further fact that the laboratory cars being
of special design and equipment, could be manufactured in limited numbers,
none other than the four above mentioned were procured.'*
On November 4, the chief surgeon wrote the director of the Motor Transport
Corps that the time consumed in the manufacture of specially constructed
laboratory trucks and bacteriological cars had been so protracted, and the diffi-
culty of their transport to France so great, that ordinary cargo trucks had been
substituted for them and that the specially constructed laboratory trucks were
not needed.'^
When the Armistice was signed two of these motorized laboratory units were
attached to the general laboratory, one was with Army laboratory No. 1 at
Neufchateau, and one with the Second Army.^ Motorized laboratories, or
field laboratory cars, as they were officially designated, are further discussed
under Army laboratories below.
Circular No. 40 of the chief surgeon's office published July 20, 1918, provided
that the laboratories of the American Expeditionary Forces would be of two
general types, stationary and transportable. The latter were to serve evacua-
tion and mobile hospitals and divisions, and their equipment was to consist of
standardized, expendable units in chests.
In the period from July to November, 1918, a large number of hospital
centers were established and the equipment and organization of these were
expedited.
In September, 1918, a bulletin was prepared by the commanding officer of
the central laboratory, which covered in detail all matters relating to the pro-
curement of laboratory supplies by Medical Department units, A. E. F.^ This
bulletin which provided for a standardization of equipment was distributed to
all units. It is reproduced in the appendix.
On September 19, 1918, the Surgeon General wrote that he desired that the
field laboratories be numbered, and he allotted to the chief surgeon numbers
from 1 to 45, inclusive, for such of these formations as already were overseas or
en route. Records of the Surgeon General's office at that time showed that
laboratories had been sent to France with 31 divisions, but had not accompanied
(3 others. In reference to this record the director of laboratories stated that
162
ADMIXISTHATIOX, AMEHICAX FA'PEDITIOXAHV FORCES
in point of fact many of these units had not actually accompanied their divi-
sions from the United States; that some had come after them, and that in all
instances it had been necessary for the director of laboratories to find personnel
in the American Expeditionary Forces who could be trained and assigned to
this service.^' In view of the signing of the armistice the proposed enumera-
tion of laboratories engaged in field service never became effective."
ACTIVITIES
As soon as the central laboratory was thoroughly organized the develop-
ment was begun of those phases of its activities which related more particularly
to the general activities of the laboratory service throughout France.^
The central laboratory came into more intimate contact with the American
Expeditionary Forces in general than did any other section of the division of
laboratories.^ It was planned that the officer commanding this institution
would, with those at the head of other sections of the division, have his main
office in that of the director of laboratories where he would be engaged only
in larger problems affecting the service of the laboratory to the entire American
Expeditionary Forces and that his adjutant would care for the administrative
details intrinsic to the central laboratory itself.^ But because of shortage of
personnel, this plan was not practicable and the commanding officer of the
central laboratory, in addition to supervising its professional work, and con-
forming its general activities to the plans of the director of the division, dis-
charged in great detail many administrative duties connected with its organiza-
tion, equipment, and operation.^
The central laboratory at Dijon and the other laboratories in the division
of laboratories were highly coordinated, and except as specified below, their
activities were developed concurrently.^ These common interests included
technical advice on general bacteriology, immunology, serology and other
laboratory procedures, control of epidemics, bacteriology of war wounds,
special instruction, personnel, laboratory equipment and supplies, gross and
histopathology, museum and art service, photographic history of Medical
Department activities, inspections, medical and surgical research, and liaison
with other services.^
The activities of the central Medical Department laboratorj'^ which was in
reality the headquarters laboratory for the American Expeditionary Forces
conformed to those itemized on the project submitted January 11, 1918, which
is quoted in the preceding chapter. These activities may be summarized as
follows: '
Bacteriology. — ^The work consisted in the standardization of technical
bacteriologic methods; the investigation of new technical methods; the prep-
aration of all culture media for stocking transportable laboratory units and
mobile laboratories in the zone of the advance; laboratory studies on the inci-
dence of communicable diseases, notably influenza, pneumonia, diphtheria,
meningitis, and intestinal diseases; the isolation, intensive study, and classi-
fication of the aerobic and anaerobic bacteria concerned in wound infections
and gas gangrene; experimental and practical tests of the efficacy of antitoxic
sera in the prophylaxis and therapy of gas gangrene; the identification of cul-
ORCiAXrZATrOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 163
tures of microorganisms received from other laboratories; the preparation of
bacterial antigens and vaccines; the propagation and study of lice concerned
with the transmission of trench fever. These activities were carried on in
addition to the ordinary routine bacteriologic examinations.^
Serology. — This included standardization of the Wassermann test and
manufacture and supply of amboceptor and antigen to all laboratories per-
forming the test. The diagnostic sera furnished the laboratories of the Ameri-
can Expeditionary Forces for the identification of pathogenic microorganisms,
as well as human sera for typing donors and recipients for blood transfusion,
were prepared in this division. A considerable volume of routine serologic
work, notably Wassermann tests, was also accomplished.^
Pathology. — Pathology w^as concerned wdth the performance of all autopsies
at Base Hospital No. 17, at Dijon, the gross examination and histologic study
of operative and autopsy tissues; the collection and preparation of specimens
for the Army Medical Museum, and the review of the protocols of all autopsies
performed in the American Expeditionary Forces. The latter activity was
of value in checking errors in diagnosis. A collection of photographs, moving-
picture films, paintings, charts, etc., was prepared for the Army Medical
Museum.^ The administration of the pathological service is considered at
greater length elsewhere in this volume.
Chemistry. — The activities of the chemical laboratory covered routine
medical chemistry, the examination of foods for the Food and Nutrition Section
and the Quartermaster Department, toxicological examinations, investigations of
the medical properties of mustard gas, examination of drugs and other supplies
furnished the Medical Department, and sanitary and industrial water analyses.'
During battle activities this division manufactured many thousand liters
of gum-salt solution for intravenous use in the resuscitation of the seriously
wounded.' The laboratory also prepared standard solutions and reagents for
transportable laboratories and such other laboratories as were not equipped
to prepare their own.' So much of the chemical service as pertained to
the water supply or food and nutrition sections is discussed with those subjects
elsewhere in this volume.
Surgical research. — In the laboratory of surgical research experimental
studies on animals were fruitful in their bearing on the prevention of wastage
from battle casualties. The cause, prevention, and treatment of surgical shock
were studied experimentally here and the results applied practically at the front
during the Chateau Thierry and subsequent military operations. Experimental
attempts to place wounds of the chest in the category of those amenable to
treatment by "debridement," and studies of the relation of various anesthetics
and methods of anesthesia to the production of shock were also made.'
Epidemiological investigation. — Perhaps the most important work of the labo-
ratory from the practical point of view w-as that concerned with the labora-
tory and epidemiologic investigation and control of communicable diseases.'
Specially trained commissioned and enlisted personnel with mobile equipment
were held in reserve at this laboratory for the prompt investigation of epidemics
or threatened epidemics anywhere in the American Expeditionary Forces. By
bacteriologic detection of early cases of communicable diseases, mild cases
164
Ar)>riXlSTRATIOX, AMERICAN' EXPEDITIOXAR V FORCES
missed clinically, and carriors, this laboratory did much to prevent the spread
of influenza, pneumonia, diphtheria, meningitis, and enteric infections, and thus
decreased the wastage concomitant with outbreaks of these diseases when not
detected early and eft'ectually controlled.'
Supplies. — The supply division of this laboratory was charged with assem-
bling, equipping, and issuing transportable laboratory equipment to mobile
units; replenishing expendable items and replacing those that had become
unserviceable; issuing to mobile laboratory units and to camp hospitals various
culture media and reagents required for bacteriologic work in the field; and
issuing to all Medical Department units in the geographic region served by the
central Medical Department laboratory, the various biologic products used in
the diagnosis, prevention, and treatment of infectious diseases.' During the
period of active participation of our troops at the front, the greater portion of
these supplies was delivered by courier service, necessitating the constant
operation of numerous motor trucks and motor cycles.'
Courses of instruction. — From its inception this laboratory conducted
courses of instruction in professional subjects.' One hundred and fifty-eight
student officers were given two-week courses of instruction in the bacteriology
of war wounds; while in the laboratory of surgical research a six-day course,
repeated weekly, was given to prospective members of shock teams. This
course covered the experimental evidence that had been gathered concerning
the cause, prevention, and treatment of surgical shock, and its practical applica-
tion to the resuscitation of the seriously wounded. Selected student officers in
lesser numbers were also given special courses in epidemiologic laboratory
methods, in serologic work, and other laboratory procedures.'
Cooperation with Chemical Warfare Service. — In August, 1918, close contact
was established with the consulting pathologist of the Chemical Warfare
Service, A. E. F., and arrangements were completed for study of the effects
produced on human beings by known and unknown types of gases.
REFERENCES
(1) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file, Historical Division, S. G. 0.
(2) Report from Col. J. F. Siler, M. C., director of laboratories and infectious diseases,
A. E. F., to chief surgeon, A. E. F. (not dated). Subject: Activities of division of
laboratories and infectious diseases, from August, 1917, to July, 1919. On file.
Historical Division, S. G. O.
(3) Letter from the general purchasing officer, A. E. F., to Daird and Tatlock (Ltd.)
London, August 19, 1917. Subject: Motor bacteriological laboratories. On file
A. G. 0., World War Division, chief surgeon's files (322.3271).
(4) First indorsement, Hdqrs., A. E. F., chief surgeon's office, to director of laboratories,
A. E. F., January 12, 1918, on letter from director of laboratories, A. E. F., to the
chief surgeon, A. E. F., January 7, 1918. Subject: Purchase of laboratory equip-
ment. On file, A. G. O., World War Division, chief surgeon's files (322.3271).
(5) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., January
11, 1918. Subject: Organization of the division of laboratories and infectious
diseases. On file, A. G. O., World War Division, chief surgeon's files (321.630).
(6) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., January
11, 1918. Subject: Mobile motor bacteriological laboratory. On file, A. G. C,
World War Division, chief surgeon's files (322.3271).
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 165
(7) First indorsement from the chief surgeon, A. E. F., to the director of laboratories,
A. E. F., January 14, 1918, on letter from the director of laboratories, A. E. F., to
the chief surgeon, A. E. F., January 11, 1918. Subject: Mobile motor bacteriological
laboratory. On file, A. G. O., World War Division, chief surgeon's files (322.3271).
(8) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., February 4,
1918. Subject: Expansion of transportation for laboratories. On file, A. G. O.,
World War Division, chief surgeon's files (321.630).
(9) Cablegram from General Pershing, A. E. F., to The Adjutant General and to the
Surgeon General, U. S. Army, February 11, 1918. Copy on file, A. G. O., World War
Division, chief surgeon's files (322.3271).
(10) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., March
1, 1918. Subject: Motor laboratories. On file. A. G. O., World War Division,
chief surgeon's files (322.3271).
(11) Report of the chief surgeon, A. E. F., to the commanding general, S. O. S., A. E. F.,
April 17, 1919. Subject: The Medical Department, A. E. F., to November 11,
1918. On file, Historical Division, S. G. O.
(12) Telegram from Maj. George B. Foster, M. C, to the chief surgeon, A. E. F., April 29,
1918. On file, A. G. 0., World War Division, chief surgeon's files (322.3271).
(13) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., May 2,
1918. Subject: Schedule of transportation. On file, A. G. O., World War Division,
chief surgeon's files (451).
(14) First indorsement from the chief surgeon, A. E. F., to the director of laboratories,
A. E. F., May 6, 1918, on letter from the director of laboratories, A. E. F., to the
chief surgeon, A. E. F., May 2, 1918. On file, A. G. O., World War Division, chief
surgeon's files (451).
(15) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., July 8,
1918. Subject: Transportation. On file, A. G. O., World War Division, chief sur-
geon's files (322.3271).
(16) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., July 16,
1918. Subject: Transportation. On file, A. G. O., World War Division, chief
surgeon's files (322.3271).
(17) Letter from Lieut. Col. J. F. Siler, M. C, director of laboratories, A. E. F., to the
chief surgeon, A. E. F., May 22, 1918. Subject: Table of organization for laboratory
units. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(18) Report on mobile laboratories by Capt. C. O. Rinder, M. C, (not dated). On file,
Historical Division, S. G. O.
(19) Letter from the chief surgeon, A. E. F., to the director of laboratories, A. E. F., Novem-
ber 4, 1918. Subject: Bacteriological cars. On file, A. G. O., World War Division,
chief surgeon's files (322.3271).
(20) Letter from the Surgeon General, U. S. Army, to the chief surgeon, A. E. F., September
19, 1918. Subject: Mobile laboratories. On file, A. G. O., World War Division,
chief surgeon's files (322.3271).
(21) Second indorsement from the director of laboratories, A. E. F., to the chief surgeon,
A. E. F., October 24, 1918, on letter from the Surgeon General, U. S. Army, to the
chief surgeon, A. E. F., September 19, 1918. Subject: Mobile laboratories. On
file. A.' G. O., World War Division, chief surgeon's files (322.3271).
(22) Sixth indorsement from the director of laboratories, A. E. F., to the chief surgeon,
A. E. F., November 21, 1918, on letter from the Surgeon General, U. S. Army, to
the chief surgeon, A. E. F., September 19, 1918. Subject: Mobile laboratories. On
file, A. G. O., World War Division, chief surgeon's files (322.3271).
(23) Letter from pathologist of Chemical Warfare Service to Maj. William Elser, M. O. R. C,
through director of laboratories, A. E. F., August 5, 1918. Subject: Instruction to
pathologists, cooperating with Chemical Warfare Service. On file. Historical
Division, S. G. O.
CHAPTER XI
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
THE SECTION OF LABORATORIES;" TECHNICAL WORK OF LABORATORIES
THE SECTION OF LABORATORIES
The laboratory section of the division of laboratories was distinct from
the central laboratory, but closely connected with it.^ Its headquarters at
Dijon exercised technical supervision over the Medical Department laboratories
throughout the American Expeditionary Forces, and was charged with their
inspection and supply, the pathological service of the American Expeditionary
Forces, special research, the collection of museum specimens, photographs,
and other art records of medical department activities, cooperation with the
water supply and gas defense services, and the destruction of rodents.'
From the viewpoint of the nature of their activities, the laboratories of
the American Expeditionary Forces were divisible into two general types which
were comparable, respectively, to the laboratories which served boards of
health in civil communities, and those which served hospitals.'
The base laboratories located in the sections of the Services of Supply,
and the mobile units attached to armies and the divisional units were concerned
mainly in the control and prevention of transmissible diseases, while the prin-
cipal activities of all other units were similar to those carried on in laboratories
pertaining to the larger and better hospitals in civil communities in the United
States.'
Also, from the viewpoint of equipment, the laboratories of the American
Expeditionary Forces could be classified into two general categories: Station-
ary or mobile.' The equipment furnished the stationary units was quite
similar to that used in hospitals in civil communities in the United States
though in some respects it was not so elaborate. For example, provision of
apparatus for blood chemistry was considered but was excluded because of its
very questionable practical importance under war conditions.' On the other
hand, the equipment furnished laboratory units attached to the headquarters
of the armies, to evacuation and mobile hospitals, and to divisions was packed
in special chests to facilitate transport. These units were constantly moving
from place to place as the zone of battle activity shifted from one section to
another.'
The general laboratory system for the American Expeditionary Forces is
shown diagrammatically in Figure 8.
As sh(fwn by Table 4, 278 laboratories conforming to the different types
outlined above were in the service of the American Expeditionary Forces on
November 11, 1918, the date the armistice was signed.'
» The Medical Department laboratories which did not pertain to the division of laboratories of the chief surgeon's
office are discussed in other chapters of this volume. Thus the dental laboratory is discussed under the chapter pertaining
to dental division of the chief surgeon's ofTice.
Id/
168 ADMINISTRATION', AMEKIC'AN KXPKDITION AHV lOUCECi
Table 4. — Tijpcs and numbers of laboratories in operation in the American Expeditionary
Forces, May, 1917, to April, 1919 '
1917
1918
1919
May 1
June 1
July 1
3
■*<
i.
Oct. 1
Nov. 1
Q
B
X!
Mar. 1
Apr
Ma\
1 Junr
1 July
en
3
<;
a
u
o
1 Nov.
1 Dec.
1 Jan.
a>
1 Mar.
1 Apr.
Central Medical Department labora-
tory
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Base laboratories, sections of Serv-
ices of Supi)lv "
1
1
1
1
1
1
3
3
5
5
7
7
7
7
10
10
10
10
9
9
8
8
Bas(> laboi alories, in hospital centers
(iiicliidol in next line)
1
1
1
2
2
5
7
11
14
16
17
17
11
9
9
8
Base hosiiital laboratories
1
5
7
7
8
9
13
14
15
19
20
25
33
47
57
84
87
112
112
82
66
47
45
1
2
3
3
4
24
24
25
25
33
33
42
45
51
56
63
58
61
59
3
3
3
4
8
8
8
12
23
25
37
37
24
20
9
IS
1
2
3
5
7
10
12
13
3
5
4
1
American Hcd Cross hospital labora-
3
3
3
3
3
3
3
3
3
3
4
4
4
8
15
18
18
19
19
19
14
12
9
8
3
3
4
5
6
8
14
21
33
35
36
36
28
21
16
13
Total.
3
4
9
11
11
13
15
20
30
32
60
63
77
92
128
154
218
232
278
284
224
192
155
153
Base hospitals with British
3
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
3
1
1
1
» In this table Array Laboratory No. 1 is listed as a base section laboratory.
St:R\ icf:s oi
Supply
liASE Sections Intermediatf: Section
Advance Section
Z.C3rvJE
Ad\?Cnci:
Fig. 8.— Diagram showing types of laboratories in the American Expeditionary Forces
INSPECTION OF LABORATORIES
In January, 1918, certain officers of the laboratory service made a iiurried
visit of inspection to the then existing centers of activity of the American
Expeditionary Forces, in order to acquire first-hand knowledge of the laboratory
personnel and equipment then available, to inspect available sites for the
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 169
establishment of base laboratories in the sections of the Services of Supply
and to expedite the organization and development of those units. ^ This was
the beginning of a system of general inspection which later was actively devel-
oped.' This inspection service was under the charge of the officer command-
ing the central laboratory, but it was quite impossible for him to cover more
than a small part of this phase of the work alone and at the same time perform
his other duties. When new areas were to be occupied by the American
Expeditionary Forces or new projects were contemplated, that officer visited
the area concerned and after consultation with its senior medical officer, made
a survey of the general situation from the viewpoint of laboratory require-
ments, conferred concerning the latter's recommendation, and submitted a
report to the director of laboratories covering the situation, with recom-
mendations to meet it.' When the director, or other officer, returned from
a trip of inspection a conference was held and verbal reports were made, fol-
lowed by a written report that was circulated in the office of the director of
the division.'
This inspection service gave the director and his assistants an infinitely
better conception of existing conditions than could have been obtained other-
wise, resulted in a much higher degree of coordination in the laboratory service
at large, and enabled the director on many occasions to make decisions of
much greater value to the service than would have been possible had this
system of inspection not been in force.'
STATIONARY LABORATORIES
Base Laboratories Assigned to Sections of the Services of Supply
In accordance with the original plan of organization one base laboratory
was established for each section or other subdivision of the Services of Supply.'
These units were under the direct control of the section surgeon and were
located at the headquarters of each section, except that the laboratory for the
intermediate section was at Tours, that for the advance section at Neufchateau,
and that for base section No. 3, at Winchester, England. These base labora-
tories occupied permanent buildings and were completely equipped for general
laboratory work, affording general and special laboratory facilities for troops in
the section who were not served by other laboratories.'
Their activities consisted of clinical examinations, general and special
bacteriology, general and special serological work, the distribution of culture
media, laboratory examinations of water supplies, the investigation of out-
l)reaks of epidemic diseases and such other activities as the section surgeon
deemed advisable.' They were established as rapidly as the necessity for them
arose and personnel and equipment became available.' The first unit of this
type. Army laboratory No. 1, was established as mentioned above, at Neuf-
chateau, in September, 1917, and the last at Le Havre, in September, 1918,
where it served Base Section No. 4. By that time a laboratory of this type
was operating in each section or other subdivision of the Services of Supply.'
In the original plan of organization for these units provision was made
for the transportation necessary to carry out field surveys of water supplies,
to investigate outbreaks of epidemic diseases and to forward therapeutic sera
170
ADMINI^^TKATION, AMEKKAX KXI'EDITIONAH V FORCES
emergencies, but the transportation problem in the American Kxpeditionary
P\)roes was of such a nature that vehicles were not always available for the
effective prosecution of these duties throughout the areas they sought to serve.'
The following brief history of the base laboratory for Base Section No. 5 is
illustrative, to a degree, of those of other sections of the Services of Supply.
Base Laboratory, Base Section No. 5
This laboratory was organized in February, 1918, under the title of sta-
tionary laboratory No. 2.^ This occurred in Washington, D. C, where the
various officers and men connected with it assembled and remained on duty
until their departure for France, May 1, 1918. On arrival in France there
were no available supplies for the laboratory, those originally shipped having
failed to arrive, and substitutes were extremely difficult to procure. These
defects, however, were gradually overcome.^ Shortly after its arrival in this
section the name of the laboratory was changed to base laboratory, base sec-
tion No. 5, under which title it continued to operate.^ It gradually developed
into a concrete organization so staffed and equipped that practically any type
of laboratory diagnosis or research could be performed.^ Its greatest activities
were the study and control of infectious diseases in base section No. 5.
About June 12, 1918, the base laboratory absorbed that of Camp Hospital
No. 33, whose premises it occupied and enlarged to four rooms. Permanent
fixtures were installed, but six weeks later, when other quarters became available,
the base laboratory left this location, which was reoccupied by the laboratory
of Camp Hospital No. 33.^ In August, 1918, the base laboratory was installed
completely equipped in a house in Brest, formerly a private residence, but
which lent itself well for the purposes.^
In the organization of this unit various departments were created, each in
charge of the officer best qualified for that particular work. As far as possible
these departments were kept strictly separated that their work might be unham-
pered by the necessity of their respective personnel undertaking other work for
which they w^ere less qualified.^ The departments consisted of office and
records, property, bacteriology, pathology and serology, chemistry, and water
control. In the investigation of infectious diseases in this base section the labo-
ratory was entirely dependent upon the activities of its own personnel to secure
specimens for examination.^ The respiratory infections w^hich sw^ept through
base section No. 5 in the fall and winter of 1918 were studied by the bacterio-
logical and pathological departments. Cultures were made from the sputum
and the various organs at autopsy. All organisms secured were carefully typed
and, when possible, preserved for future study. The bacteriological and patho-
logical work done in common with these diseases was of an advanced and
extremely thorough character. All this work was done under the direct
supervision and at the direction of the base surgeon base section No. 5.
Complete liaison, both official and unofficial, existed between this organi-
zation, the local hospitals, and the Engineer Corps. ^ Most of the laboratory
activities pertained to the service of these agencies. The chief association with
the engineers related to the water supply of Brest, and that with hospitals to
the control of infectious diseases.^
ORGANIZATION' AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 171
In addition to the duty indicated above this organization exercised a
general control and supervision over the smaller laboratories attached to hospi-
tals in and about Brest, and in a way served as a supply depot not only for
laboratory material but also for therapeutic and diagnostic sera.^ The thera-
peutic sera were secured by requisition, as were some of the diagnostic sera,
but most of the former were prepared by the department of bacteriology con-
nected with the base laboratory.^ Hospitals in the vicinity were supplied sera
on requisition by means of the light truck above mentioned. All trans-
Atlantic transports requiring sera were supplied in like manner on telephonic
request that was later confirmed in writing. Because of the fact that they were
frequently demanded in emergencies, these supplies were sent out day or night,
for the laboratory operated throughout the 24 hours of the day.^
A great handicap, which this laboratory experienced and which caused
marked detriment to complete efficiency, was inadequate transportation.
After great difficulties this laboratory secured a light truck, which alone
made it possible for its personnel to cover much ground and secure the speci-
mens requested in connection with the control of infectious diseases.^ The one
vehicle permanently supplied was not sufficient to meet the demands, and the
procurement of other transportation from the Motor Transportation Corps
was very uncertain and inadequate. This feature caused much loss of valuable
material and time. Another handicap was the fact that supplies were limited,
for it was always difficult and sometimes impossible to obtain them.^
Base Laboratories for Hospital Centers, and Hospital Laboratories Serving in
Centers
Plans for the organization of the laboratory service had considered the
conservation of personnel, equipment, supplies, and construction, in order to
release tonnage and to utilize resources to the best advantage.^ In the labora-
tory service of the large hospital centers which were made up of several base
hospital units great economies were thus effected. Each base hospital included
in its personnel two or more commissioned laboratory officers, a varying number
of enlisted technicians, and a complete laboratory equipment. By centraliza-
tion of the laboratory service the efficiency was increased, personnel released,
equipment conserved, and construction diminished.' Therefore, in each hospital
center one base laboratory for the entire service of the center was organized
and one small clinical laboratory established for each base hospital unit.
The laboratory for the center was part of the headquarters organization, and
its commanding officer the representative of the commanding officer of the
center in all matters relating to the laboratory service. Its personnel consisted
of selected officers and enlisted technicians drawn from the hospital units
comprising the center; its equipment was drawn from the same sources.'
Standard plans for the laboratory buildings for the centers and for smaller
clinical laboratory buildings for each unit were prepared in the office of the
director of laboratories, A. E. F., and turned over to the hospitalization division
of the chief surgeon's office for inclusion in the general plans of construction.'
The original plans provided for two standard barracks for the base laboratory
and one small building for each hospital unit functioning in the center, but the
172
ADMIX ISTHATIOX, AMERICAN EXPEDITIONARY FORCES
accommodations for the base laboratory were later reduced to one building
because of scarcity of materials.'
The base laboratory for the center in general performed such routine
clinical and pathological work as might be necessary, all highly tecliiucal
bacteriological and serological work for the center, and prepared cidture media
and special reagents, which it issued to the subsidiary clinical laboratories.'
Those organizations operating in the several base hospital units composing
the center carried on the clinico-pathologic work for their respective units.'
The general method outlined above was that followed in the large hospital
centers of temporary construction.^ In the large centers which utilized per-
manent buildings that were a considerable distance apart it was not always
possible to centralize the work so definitely.* However, by November, 1918,
a laboratory service which conformed in general to the method outlined above
had been established in all hospital centers operating in the American Expe-
ditionary Forces.*
In those hospital centers where permanent buildings were utilized the
laboratory services were housed in such rooms or buildings as were found most
suitable for their purposes without extensive alterations.^ The laboratories,
therefore, at these centers varied considerably in size and character, ranging
in size, for example, from a temporary wooden building erected for laboratory
work at the hospital center at Limoges to an entire hotel equipped for laboratory
purposes at the hospital center at Vichy
At all the hospital centers except that at Vichy the laboratory work was
organized in conformity with Memorandum No. 8, July 23, 1918, division of
laboratories and infectious diseases.^ As this memorandum is reproduced in
the appendix it is sufficient here to state that it provided for a laboratory
officer who, as a member of the staff of the commanding officer of the center,
would exercise control over its entire service, in so far as his specialty was
concerned, and for the establishment of a center laboratory and unit labora-
tories.^ Each of the hospitals composing the center was to be served by a
unit laboratory. The center laboratory w^as to perform such examinations
as required greater time and more technical skill, while the unit laboratories
were to perform ordinary routine clinical pathological examinations.^
In order to illustrate the laboratory activities at these centers there follows
the history of that service at Mesves and at Vichy. The organization and
activities of the laboratory service at Mesves, which grew to be the largest
center in France, were typical of those in other centers,^ except Vichy. This
service at Vichy is, therefore, described also because of its unique character.
Typical Laboratory Organization of a Hospital Center (Mesves)
The first base hospital assigned to Mesves, arrived August 1, and on August
3, a laboratory officer for the center was assigned.^ Efforts were inaugurated
and continued to provide accommodations, equipment and organization for
the laboratories of base hospitals as they successively arrived. Construction
w^as expedited, by loaning to these units a Medical Department tool chest,
by which construction of much apparatus, shelving, furniture and other articles
was expedited— apparently a minor matter, but one which proved of very
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 173
great importance. Supplies were procured on requisition from intermediate
medical supply depot No. 3.^
In conformity with Memorandum No. 8, division of laboratories and
infectious diseases, July 23, 1918, the laboratory organization for this center
comprised (1) a central laboratory whose commanding officer was a member of
the staff of the commanding officer of the center, and supervised all its labora-
tory activities; and (2) unit laboratories, viz, one for each of the hospitals
composing the center and the convalescent camp. The work of these de-
partments was divided as follows:^
Center laboratory: (a) Special pathology (gross and miscroscopic) ; (b)
special bacteriology (pneumococcus type, typhoid, and dysentery); (c) Serology
(agglutination and complement fixation reactions) ; (d) general board of health
for center (water analysis, carrier work); (e) preparation of media, purchase
and requisition of supplies).
Unit laboratories: (a) Gross pathology (autopsies on all patients dying in
hospital) ; (h) bacteriology (general culture work, blood, throat, wound, etc.) ;
(<■) general clinical pathology (urine, sputum, blood, feces, etc.); (d) prepara-
tion of Dakin's solution, care of unit water supply, etc.
This partition of duties w^as inaugurated August 15, 1918, and continued
unchanged, though in September it was apprehended that laboratory supplies
available for incoming units might not be adequate for the performance of all
the duties allotted them. Laboratory work, however, was simplified by the
practice of distributing patients, according to their ailments, among the hos-
pitals best equipped and otherwise qualified to care for them.^ The distribu-
tion of duties proved highly satisfactory, but a conviction grew that centraliza-
tion of post-mortem service and burials might have been advantageous, although
this would have deprived clinicians of opportunities to attend autopsies in
which they were interested.^
The center laboratory, until September 17, occupied quarters in common
with those of Base Hospital No. 67, when it moved to a special building provided
for it. This was 100 by 20 feet in dimensions and was later supplemented by
a cool room 6 feet by 6 feet 6 inches, and an animal house 13 by 26 feet. These
buildings were occupied several weeks before they were equipped with light,
water, or sewer connections.^
Each unit laboratory centrally located in the hospital which it served
occupied a building 20 by 40 feet, divided originally into an autopsy room, a
morgue, and a clinical laboratory, but several changes were made in the interior
plan of these structures. Each laboratory built most of its interior fittings.
All laboratory supplies reaching the center were invoiced to the center
laboratory officer and by him issued on memorandum receipt to the unit
laboratories. In connection with such supplies, many economies and improvi-
sations proved necessary. The supplies most difficult to obtain were those
commonly used articles not listed in Memorandum No. 21 from the division
of laboratories and infectious diseases, e. g., stoves, books, basins, pens, wire,
etc. Animals, except mice, were procured without difficulty.^
Records were kept in the following manner: Request slips were made out
in the wards and on these slips laboratory findings were entered, the slips then
174
ad:mixistkatiox, American kxi'kditioxahv fohce.s
being returned to the wards. Retained laboratory records consisted of (1)
a journal or daybook in which all specimens or requests were listed; (2) a file
of index or ledger cards on which the reports mentioned above were transcribed.
All the work done on a given case was entered on one or more of these cards.
This system simplified clerical work and facilitated cooperation with the clinical
services.^
General reports of infectious diseases were carried on spot maps and on
separate card indices for the more important diseases — pneumonia, diphtheria,
typhoid, dysentery, meningitis, and scarlet fever. These records were obtained
from (1) the morning report of infectious diseases, (2) from individual reports
of cases which were required by a special memorandum of the commanding
officer of the center, and (3) from the medical consultant. Each case of diph-
theria, meningitis, and typhoid fever was personally investigated by an officer
from the center laboratory. Routine reports of water analyses were made to
the center sanitary inspector and to each hospital. The locations of all Lyster
bags were posted on spot maps, to facilitate checking the routine bacteriological
examinations.^
The laboratory staffs of the entire center consisted of 29 officers, 7 nurses
or civilians, who had had previous laboratory experience, and 63 enlisted men.
Of this number 5 officers, 1 technician, and 15 enlisted men served at the center
laboratory, while the others were distributed among 8 base hospitals, 2 provi-
sional base hospitals, 2 evacuation hospitals, and the convalescent camp.^
The idea of developing the laboratory service from a central laboratory
with subsidiary laboratories in each hospital organization proved practical and
efficient. As each hospital occupied somewhat the same position in the center
that the regiment held in a division, this organization, more than any other
factor, simplified the development and operation of the laboratory service.
The old and established functions of the laboratory proved of most value,
but the preparation of Dakin's solution and the supervision of the water sup-
ply in each hospital by its laboratory, in addition to the regular bacteriological
examinations of the camp water supply, were other valuable services. Wound
bacteriology and pneumococcus typing proved of little practical importance.
With the exception of influenza and influenza pneumonia, there were no
epidemics in this center. Diphtheria was the most prevalent of the carrier-
borne diseases (151 cases), and the number of diphtheria carriers detected was
correspondingly high (112 cases). The presence of diphtheria and of virulent
diphtheria-like organisms in wounds was frequently noted. Twenty-six cases
of cerebrospinal meningitis were treated, of which 12 died. Twenty-five of
these cases developed in this center. Seventy-three cases of typhoid fever, one
case of paratyphoid A, and two cases of paratyphoid B were treated, of which
total, 21 were believed to have originated here. Thirty-eight of these cases
were verified bacteriologically.^
The Laboratory Service, Hospital Center, Vichy
The organization of the laboratory service at the hospital center at Vichy
differed from that in other centers because of the fact that it appeared advisable
to centralize all laboratory personnel and equipment. This decision arose
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 175
from the fact that the hospitals comprising the center operated in some 80
hotels which varied in their capacity from 50 to 1,200 beds. Because of the
consequent unevenness in the distribution of buildings and bed capacity,
operation of unit laboratories would have been difficult. In one hotel, accom-
modating 1,200 beds, one small subsidiary laboratory was established but
this was the only departure from this plan for centralization.^
The laboratory equipment of the five base hospitals at this center was,
therefore, assembled at the center laboratory to which all Medical and Sanitary
Corps ofl&cers belonging to the laboratory staffs of the various base hospitals
were assigned. Enlisted men who had had previous experience as laboratory
technicians, photographers, and artists from all organizations were similarly
assigned.^
The laboratory and its enlisted personnel occupied an entire hotel with the
exception of three small rooms which were assigned to the American Red
Cross for office purposes.^
In this, as in other centers, an experienced laboratory officer who was
assigned to the staff of the commanding officer of the center, organized and
controlled its laboratory service, and was responsible for its activities.^
The laboratory staff here consisted of the following personnel:^ Medical
officers, 9; Sanitary Corps officers, 2; civilian employees, 4; enlisted men, 35;
French employees, 7; total, 57. This personnel was distributed among the
following departments: Administrative, pathological (including clinical and
neuropathological), bacteriological, serological, art, photographic, and preparation
of media.^
The administrative department had charge of the laboratory building, its
proper policing, discipline of the enlisted personnel, the cleaning of glassware,
operation of stock rooms, collection of specimens, and the issue of laboratory
reports.^
The assistant director of the laboratory took complete charge of any large
bacteriological problems that arose, such as extensive investigations for diph-
theria, meningitis, or typhoid carriers, and was authorized to detail as his
assistants any subordinate member of the laboratory staff. ^
So far as possible the laboratory staff of each of the five base hospitals
composing this center performed the routine laboratory work of their respective
hospitals; e. g., clinical pathology, wound bacteriology, etc. Therefore, the
service for each base hospital was left in charge of its own pathologist who was
responsible to the laboratory officer of the center through the assistant director
of the laboratory.^
The pathological department had entire control of the autopsy service
and of surgical pathology. The laboratory officer of each unit performed
practically all the autopsies pertaining to it, but the brains and spinal cords
were removed by the neuropathologists and their technicians. All patients
dying at this center were autopsied, a stenographer taking the dictated protocol
at the post-mortem table. Almost every autopsy included an examination of
the brain, spinal cord, and accessory sinuses of the head.^ This department
was able to prepare microscopic sections of the important viscera from most
13901—27 12
176
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
of the autopsies, to study them, prepare microphotographs and, with the aid
of the art and photographic departments, to make drawings of gross and
microscopic lesions. Clinical pathological meetings which the entire medical
staff of the center were requested to attend were held three times a week in the
lecture room of the laboratory. At these sessions clinical histories of all cases
coming to autopsy were read and discussed, the gross anatomic material was
demonstrated, and microscopic sections, drawings, charts, etc., were exhibited.^
Fig. 9.— Pathological room in the laboratory, Vichy hospital center
Wassermann tests, the typing of pneumococci, weekly water analyses
and such other procedures as required more or less routine work, were assigned
to a few officers and men and the individual base hospitals' laboratory staff
was thus relieved of these duties.^
Though serology was done by the department of that name there was
always opportunity for the laboratory staff of each base hospital to perform
any of this work, if they so desired and had the time.^
The art and photographic departments had charge of all the medical
art work of the center. Reenforced by a special group sent from the United
States, this department was engaged in taking photographs of clinical cases,
making black and white drawings, and colored drawings of gunshot wounds,
ORGANIZATION AND AD:MINISTRATI0N OF CHIEF SURGEON'S OFFICE 177
mustard gas burns and peripheral nerve injuries. It also took photographs
or made drawings of surgical specimens, autopsy lesions and constructed
plaster or wax models of facial injuries and other lesions. When the armistice
was signed, this department was prepared to furnish on request, medical photo-
graphs and artists to other hospitals. It was planned and to a large degree accom-
plished that this center be made a collecting point for medical art work in
the American Expeditionary Forces.^
The basement of the hotel utilized for laboratory purposes, contained
the morgue for the entire center with a central autopsy room. Another room
on this floor used for the preparation of bacteriological media was equipped
with hot and cold water, gas and electricity. In a third room were stored the
coffins which were made by the Quartermaster Department while a fourth
room was shelved and used for the storage of antitoxins, sera, vaccines, etc.®
Offices of the laboratory officer and his assistant and a small medical library
were on the ground floor. Another room accommodated a large clinical and
bacteriological laboratory which provided a desk bench for the pathologists
and laboratory personnel of all the hospitals in the center. Most of the routine
work was done in these rooms. On the same floor were a lecture room seating
about 100 persons (also used for a museum and for the display of the work
of the art and photographic departments) and a media and chemical supply
room which served the entire laboratory.®
On the first floor were located the pathological, art, and photographic
departments. These afforded facilities for officers engaged in histology and
the preparation of gross pathological specimens for museum purposes, for
artists engaged in medical art work, for a modeler of plaster and wax prep-
arations for face masks, etc. Here were provided storage of pathological
specimens for shipment to the Army Medical Museum, a portrait studio,
and facihties for developing and mounting photographs. The brains removed
from all cadavers were hardened, studied, and stored for shipment to the Army
Medical Museum.®
The second and third floors of the hotel were used for living rooms for
the laboratory personnel, about 40 being quartered there. All the rooms in
this building were w^ell equipped with water (hot and cold), gas, and electricity.®
The laboratory equipment and apparatus were exceUent. Much of the
equipment was brought to France by the several base hospitals, but addi-
tional articles were obtained from the medical supply depot and the central
Medical Department laboratory. The equipment compared very favorably
with that seen in most large civil institutions. An elaborate equipment for
neuropathological work, consisting of large brain microtomes, etc., costing about
$18,000, was shipped to the center from the United States but was never
received.®
The methods of procedure employed by the laboratory in the service
of the scattered hospital establishments were comparable to those used by
departments of health in a civil community supporting a diagnostic bacteri-
ological laboratory.®
As glassware containers for the collection of specimens were quite limited,
small stations supplying this material were established in the largest of the
178
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
hotels occupied by the several hospitals. These culture stations, as they were
called, were usually located in the pharmacy of the building. At one time 22
of these stations were in operation, and at each the laboratory maintained an
adequate supply of the containers for urine, feces, or sputum; diphtheria
culture tubes, wound culture tubes, and "venereal outfits," the last mentioned
consisting of glass slides and swabs for taking smears.^ From each station
containers for the collection of specimens were distributed as required to smaller
buildings and conversely here were collected specimens and requests for
laboratory service.
Pasted on each container w^as a mimeographed blank for the entry thereon
of appropriate data. Similar detached blanks were kept at the culture stations
for use as requests upon the laboratory for special services.
Fig. 10.— Bacteriological laboratory, Vichy hospital center
In an emergency, e. g., a blood transfusion, or a leucocyte count in an
appendicitis case, there quest was sent direct to the laboratory by an orderly,
and dehvered to the pathologist of the hospital in which the soldier was a
patient. This officer was responsible for an immediate laboratory examination.
None of the Army forms or blanks were employed in the laboratory service
here.^
Three enlisted men, who acted as culture collectors, visited each of the
culture stations three times daily, employing a motor cycle and side car.^
All specimens brought to the laboratory by the culture collectors or sent
direct by a hospital were noted in numerical sequence on an entrv book at the
ORGAXIZATIOX AXD ADMIXISTEATION OF CHIEF SURGEON'S OFFICE 179
receiving office. The specimens were then distributed for examination and the
results of these examinations were noted upon report blanks, the laboratory
retaining a carbon copy for its file, the original copy being sent to the hospital
and ward from which the specimen came or for which the examination was
made.^
Though the laboratory at Vichy existed for a year, it operated actively
only for five months. During this time, 44,767 laboratory examinations were
made, including practically all the common tests, reactions, and procedures
required by modern clinical medicine in bacteriology, serology, clinical pathology
and pathological anatomy.^
Base Hospital Laboratories for Base Hospitals Not Operating in Centers
The laboratories of detached base hospitals performed all routine clinical
and pathological work for the organization they served. Their installation
was a matter of local administration and their operation presented no
difficulties.^
Many of the following details, taken from the history of the laboratory
activities of Base Hospital No. 27, are illustrative of the activities of those
establishments in detached base hospitals generally. This unit was selected
for discussion here because of the completeness of its history.^
The staff of the laboratory originally consisted of 3 medical officers, 1
trained nurse, and 3 enlisted men. One officer was engaged in pathology,
another in bacteriology, and the third (who gave part of his time to ward work)
in clinical microscopy, parasitology, and chemistry. Late in November, 1918,
a Sanitary Corps officer joined the staff, but at intervals one or more officers
were detached for periods of three months or less. The services of civilian
photographer and artist were made available to this unit and thus some valuable
material in this field of endeavor was procured.^
The laboratory of Base Hospital No. 27, which was located at Angers, first
occupied two rooms in a permanent building. Since these rooms were over-
crowded, a temporary structure was obtained into which the laboratory moved
as soon as the new building was completed. This building was centrally located
and was of the wooden barrack type, with cement floor and plaster walls. The
floor plan included two workrooms, measuring 6 by 12 meters, with an incu-
bator room 2.5 by 2 meters and a storeroom 2 by 2 meters between them, one
on either side of a short passage connecting the two large rooms. ^ The work-
rooms contained benches, along both sides, and center tables. Large sinks, sup-
plied with hot water and adapted to cleaning glassware, etc., were provided for
each room, and a sufficient number of small sinks for the side or center tables.
Both rooms were wired for electricity, with numerous ceiling and side lights and
a number of floor plugs at the sides of the room. Ample shelf space was pro-
vided, the storeroom being shelved to the ceiling. Gas connections were
installed along all the side tables. A hot-air steriHzer, a paraffin oven, and
a large centrifuge were operated in the incubator room, and the Arnold steril-
izer and the autoclave in the bacteriological room. As far as possible, the
reserve supply of laboratory materials w^as kept in the storeroom.^
180
ADMIXISTKATIOX, AMERICAN EXPP:DITI0N AK V FORCES
When the temporary structure was occupied, the rooms whence the labora-
tory moved were thoroughly equipped as a morgue and as a fixation room for
specimens/
The equipment originally brought to France was that estimated on the
basis of the needs of a 500-bed hospital for one year, but when the bed capacity
was doubled (or counting emergency beds, quadrupled), a requisition was sub-
mitted for corresponding additions to equipment. Availability of gas and
electricity secured the issue of apparatus not considered in the original hst of
equipment/
Arrangements for the delivery of specimens to the laboratory were left to
the respective ward surgeons, but phenolphthalein tests, diagnostic lumbar
pimctures, procurement of specimens for Wassermann tests, blood cultures, and
blood counts were all attended to on request to the laboratory staff/ Each
specimen was accompanied by a requisition slip upon which the reports desired
were entered and was returned to the proper ward by the laboratory personnel.
Laboratory records were kept for the most part in separate ledgers, one for
each class of work, e. g., blood counts, urine analysis, etc., but general bacteri-
ological findings were recorded in one book and wound bacteriology findings in
another, each in numerical sequence. Record of examinations of surgical
pathological tissues were entered on the original requests for examination.
These were retained at the laboratory and duplicates of the findings noted were
sent to the wards. Autopsy records were made on appropriate forms with his-
tological notes appended when necessary to make the diagnosis complete.
Wassermann tests were recorded on cards, each day's list being entered on a
separate card.''
The chief activities of the laboratory were clinical pathology, anatomic
pathology and clinical bacteriology. A considerable part of the bacteriological
work was incidental to the epidemiological study of cultures from this and
other hospitals in the vicinity of Angers.^ The laboratory also made the water
analysis for this region.
The somewhat limited official personnel and lack of trained technicians
necessitated such close cooperation and application to the routine work in hand
that research work was precluded.^
Camp Hospital Laboratories
Effort was made to furnish each camp hospital with laboratory service in
accordance with its requirements.* This was not entirely uniform, for these
hospitals varied greatly in size and in the nature of their service. Some func-
tioned as base hospitals; others were little more than evacuating infirmaries,
or varied between these two extremes. In November, 1918,58 camp hospitals
were operating with the American Expeditionary Forces and there is record of
laboratory service in 51 of these.
The following notes from the history of the laboratory of Camp Hospital
No. 15, exemplified to a degree the activities of these units. ^ This hospital
was organized in France from casual personnel. Its capacity was 700 beds,
expansible to 1,000 beds in emergency. Located at Camp Coetquidan, which
accommodated 20,000 troops, the hospital began to admit patients November
1, 1917.»
OBGANIZATIOX AND ADMINISTEATIOX OF CHIEF SUEGEON'S OFFICE 181
The laboratory staff consisted of one officer and four enlisted men. At first
equipment was very limited but was augmented from time to time as resources
permitted by American and French apparatus. The laboratory occupied two
rooms, with floor areas of 50 and 25 square meters respectively, in a centrally
located permanent building and utilized rooms in a neighboring structure as a
morgue and an animal house. ^
Requests for examinations as well as specimens were sent to the labora-
tory by ward surgeons. Findings were recorded in note books and reports
then rendered the ward officers. Requests from officers outside the hospital
were sent through the receiving ward, and reports returned through the same
channel.^
An important part of the laboratory service was the periodic examination
of water supplies in villages where troops were located throughout the sur-
rounding territory, and sanitary surveys, with studies pertaining to epidemi-
ology among the troops occupying the area. As meningococci were discovered
in the course of the influenza epidemic at Camp Coetquidan, approximately
8,000 cultures for these organisms were examined, of which 662 were positive.
Because of limited equipment, chemical examinations were few.^
MOBILE LABORATORIES
Army Laboratories
In the original plan of organization, a laboratory unit for each army was
provided, but it was thought best to await developments before the project
was further defined.^ Until July, 1918, all laboratory investigations of out-
breaks of epidemic diseases in the advance section and zone of the armies
were performed by personnel and motorized laboratories — i. e., "field labora-
tory cars" — sent out by the central Medical Department laboratory or Army
laboratory No. 1.^ During the Chateau-Thierry operation, a field laboratory
car was attached to the First Corps for the investigation of epidemic diseases
and it was understood by the chief surgeon of the Paris group, of which that
corps then formed a part, that this car was available for the service of the
entire group. The work of this unit in the Chateau Thierry sector proved to
be of great value, for it demonstrated that much of the so-called diarrhea and
dysentery occurring there was true bacillary dysentery, typhoid or paraty-
phoid.^
In August, 1918, it became evident that there should be attached to each
army a laboratory unit equipped to do general bacteriology, serology and
examination of water supplies.^ A transportable laboratory equipment for
service of the first army was assembled and shipped to Toul just prior to the
St. Mihiel operation (September 12, 1918). As special personnel was not
immediately available, the equipment was installed at the Toul hospital center
where the laboratory served the center and also met the emergency require-
ments of the First Army.^
During the early phases of the Meuse-Argonne operation, a field laboratory
car was attached to the First Corps of the First Army.^
182
ADMINISTRATION, AM?:RICAX EXFEDITIONAHV FORCES
When the Second Army was formed, a field laboratory car was attached
to the office of the surgeon of that army. It operated under the sanitary
inspector. Second Army, in the investigation of epidemic diseases.
When the Third Army was organized to constitute the Army of Occupation
in Germany, a survey of the laboratory requirements was made and the per-
sonnel and equipment necessary for its service were supplied.^ Army labora-
tories were established at Coblenz and at Trier, that at Coblenz being supple-
mented by a mobile laboratory.^
The laboratory service of the Third Army illustrates the full development
of this specialty in this field. On March 16, 1919, it included 2 army labora-
tories, 10 hospital laboratories with 2 annexes, and 8 divisional laboratories;
i. e., 1 for each division.^
The army laboratories were staffed and equipped to perform all the ordi-
nary duties of laboratories serving large cities or even States. The personnel
of the unit located at Coblenz consisted of 10 officers and 24 enlisted men,
excluding those assigned to the field laboratory car which also served this
army and which was attached to this unit.^ It included a commanding officer,
executive and supply officers (one officer sometimes discharging the duties of
both assignments) a pathologist and histologist, bacteriologist, water analyst,
serologist, chemist (with exceptionally broad attainments, especially in the
field of toxicology), three clinical laboratory experts, and a skilled technician.
At the army laboratories autopsies were performed, histologic diagnoses and
Wassermann tests made, bacteriologic differentiations conducted, water samples
tested and chemical analyses made of food, beverages, medicines and supplies,
e. g., chlorinating materials for water purification.^ Each of these units also
conducted a clinical laboratory service for the hospital wherein it was located
and issued supplies to other laboratories in their respective areas. The labora-
tory at Coblenz performed the usual laboratory service for Evacuation Hospi-
tal No. 27 (formerly No. 6) and sent out officers to conduct autopsies at other
hospitals.^
Attached to the Third Army laboratory at Coblenz was a field laboratory
car which was staffed by one officer and three enlisted men. This unit was of
especial value during the initial emergency and in the prosecution of surveys of
meningococcus carriers.^
The army laboratory at Trier occupied space in Evacuation Hospital No. 12,
for which it performed all the clinical laboratory service in addition to its other
duties, which were similar to those outlined above for the laboratory at Coblenz.*
Ten laboratories each adequately equipped with material packed in eight
chests, served the 10 evacuation hospitals, which in the Third Army served as base
hospitals.^ These hospitals varied in capacity from 400 to 1,800 beds and in
the character of the cases treated. In some units the cases w^ere almost entirely
medical, in others many cases were surgical; a few units were largely devoted
to the specialties. The laboratory service in each of these hospitals naturally
conformed to the character of the patients treated therein. In very general
terms this service included examination of urine, sputum, blood, cerebrospinal
fluid, feces, and the bacteriology of wounds, epidemics, venereal, cutaneous, and
ocular diseases, i. e., the usual lines of investigation connected with hospitals.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 183
The staffs of some laboratories also performed autopsies for the hospitals which
were not thus served by the army laboratories.^
No laboratories, other than the eight assigned to divisions, were provided
for the field hospitals, of which 35 were in operation. These divisional labora-
tories, each provided with 8-chest equipment, were utilized to make water
analyses, epidemiological studies and urgent clinical laboratory examinations.^
Field Laboratory Cars
Each of the field laboratory cars, which on occasion reenforced the labora-
tory service of armies, was essentially a completely equipped unit, relying on
Fig. 11.— Field laboratory car
its own motor power, but was supplemented by additional transportation con-
sisting of a Ford car and a motor cycle with side car.'° The unit could be shifted
and moved rapidly to meet varying conditions in the field as well as to cover a
large territory and was independent of field, evacuation, and base hospitals.
The additional transportation permitted sanitary surveys covering a large area
and facilitated the collection of specimens for examinations.^*^ Three of the
cars were the Peerless type and one a De Dion Bouton. They were specially
designed and equipped to meet field conditions, for oftentimes the laboratory
would work in a division removed from hospitals and other laboratories.
The equipment was compact and provided with a work bench and compart-
ments for the apparatus and supplies. The arrangement made work in the
car possible and prevented breakage while the car was being moved. The
provisions made for actually doing work in the car constituted one of its greatest
184
AD^rrXISTRATIOX, A:\rERICAX EXPEDITIONARY FORCES
advantages, but usually a room in some building was utilized for making media,
washing glassware, and for a storeroom. Occasionally one was fortunate
enough to be located where the apparatus could be set up in a separate room.'"
The equipment consisted of incubators, autoclave, hot air sterilizer, distilling
apparatus, ice chest, water bath, Wassermann outfit, centrifuge, microscope,
hemocytometer, water testing outfit, material for spinal punctures, blood cul-
tures and the usual laboratory accessories. A storage battery and generator,
connected w^ith the motor, provided electric lights. This was of great help, for
often it was necessary that work be done in the car at night. This apparatus
also gave excellent illumination for microscopical examinations. '° A gravity
water system was provided, consisting of a water tank fastened on the roof of
Fig. 12.— Front of interior of field laboratory car
the car and connected with a faucet. A sink drain was also provided. Sup-
plies were carried in the car to make the necessary media, a complete supply
of diagnostic as well as therapeutic sera, and reagents for the Wassermann test.
The equipment made possible the performance of the following laboratory
tests Routine clinical examinations, such as those of urine, blood, sputum,
smears and body fluids; examinations for typhoid, dysentery, and enteric ail-
ments generally; examination to determine positive diagnosis of meningitis and
exammation for carriers; examinations for diphtheria cases and carriers, and
performance of Schick tests; investigation of respiratory epidemics, especially
pneumonia and influenza; water analyses, bacteriological; Wassermann fixa-
tion test. These laboratories were not called upon however, for this work.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 185
Fig. 13.— Rear of interior of field laboratory car
186
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Fig. 14.— Interior of field laboratory car showing water still, autoclave, and sterilizers
ORGAXIZATIOX AND ADMINISTEATIOX OF CHIEF SURGEON'S OFFICE 187
The field laboratory car aided the sanitary inspector of an army to cope
with epidemiological problems and it was in this capacity that it was of greatest
use, though it was often called upon to assist in establishing clinical diagnoses.'*^
Being attached to army headquarters under the immediate supervision of the
sanitary inspector, reports of its findings were made to him direct. The
peculiar value of the laboratory cars rose from the fact that the divisional
laboratories usually were unable to handle the larger epidemics and sanitary
surveys, while performing their normal duties. The stationary laboratories
were not provided with transportation for extensive field work though the
collection of samples was of the greatest importance, while the excellent trans-
portation facilities of the laboratory cars enabled them to reach sites where
their services were needed and to carry supplies adequate for several months.
These supplies usually were replenished from evacuation and base hospitals.
The personnel consisted of 1 or 2 officers, 2 technicians (preferably sergeants
or sergeants, first class), and 2 chauffeurs.'^
These laboratories aided greatly in the investigation and control of typhoid
fever in the 77th and 79th Divisions; meningitis in the 7th and 90th Divisions;
diphtheria in the 32d and 35th Divisions; pneumonia and influenza in the
26th Division and in the labor battalion at Jonchery.'*^
The most important advantages which these laboratory cars presented
were the following: '" The unit could function anywhere in the field, requiring
no special housing or additional equipment and could, therefore, operate in any
area occupied by the troops. It was supplied with its own light and water
systems. Being supplied with its own motor power it was ready for immediate
service and the transportation could not be diverted for other use, thus ensuring
a mobile organization. The unit was able to handle large epidemics and to
cooperate with the army sanitary officer in solving special problems and making
surveys. It thus permitted other laboratories and those with divisions to con-
tinue their normal duties without interruption. On the other hand, the chief
disadvantages of a field laboratory car were, the initial cost of the car and its
special equipment, which was about $7,500; the car being of special design,
could be manufactured only in limited numbers, and in case of motor trouble
the whole organization was unable to function.'*'
EVACUATION AND MOBILE HOSPITAL LABORATORIES
The laboratory equipment for each evacuation and mobile hospital was
assembled in eight chests which could be packed and unpacked quickly and
could be easily transported.* It was adequate for all types of clinical and gene-
ral bacteriological work, for the performance of autopsies, and the collection
and preservation of museum specimens. As a rule, only one laboratory officer
and two technicians were assigned to the laboratory units which served hospitals
under consideration though a larger personnel originally had been contemplated.*
The personnel prior to assignment was given a special course of instruction
in wound bacteriology. It was planned that these units would perform clinical
patholog}^ and autopsies as well as general and wound bacteriology and collect
and preserve museum specimens, and work of this general character was per-
188
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
formed at those evacuation and mobile hospitals which were partially immobi-
lized and operating in quiet sectors, but after July, 1918, when a war of move-
ment began, the activities of many of these units necessarily changed.*
During 1918, the number of evacuation hospitals, each of which was
equipped with a laboratory, increased as follows, until the time of the armistice:
March, 1; April, 2; May, 2; June, 4; July, 8; August, 8; September, 13;
October, 18; November,18."
The first evacuation hospital (No. 1) was established near Toul in March,
1918, where it operated throughout the remainder of the war." Except during
periods of active military operations its services were to a degree comparable
Fig. 15.— Transportable laboratory, in eight chests
to those of a base hospital, but during active engagements they w^ere of the
character which its name indicated. As at all times it was almost exclusively
a surgical hospital, its chief laboratory activities were wound bacteriology and
post-mortem pathology. Similarly, Evacuation Hospital No. 2, established
in April, at Baccarat, was engaged chiefly in the treatment of battle casualties
and its laboratory during that period was occupied in corresponding service."
Wound bacteriology occupied intensively the laboratories of evacuation
hospitals during the period from July, 1918, to the armistice; but during periods
of greatest battle activity, laboratory officers often were detailed to assist
in the treatment of patients." After the onset of the influenza epidemic in
October, 1918, the laboratories were engaged also in the study of infectious
diseases and frequently made the diagnoses for the ward surgeons. Post-
ORGANIZATIOX AND ADiMINISTRATION OF CHIEF SURGEON'S OFFICE 189
mortem examinations which they conducted on all bodies acted as a check
against gross errors and furnished clinicians with invaluable information.
Autopsies and histological and bacteriological examinations of specimens were
made the occasion of clinico-pathological conferences.
During the Meuse-Argonne operation some of the evacuation hospitals
were specialized to a degree, a number of them receiving medical cases and a
number of others surgical. Their laboratories supplied information required
for diagnosis and treatment and for the prevention of the wider spread of
infectious diseases. In general terms the equipment of these laboratories was
very satisfactory.^^
Fig. 16.— Chests of transportable laboratory opened to show contents
When American troops took over their sector in occupied Germany this
was divided into two districts, that of Coblenz and that of Trier. Seven
evacuation hospitals served the six divisions in the Coblenz or Bridgehead
district, and two, the two divisions in the district of Trier. Since these units
operated as advanced base hospitals and some of them specialized on certain
types of cases, the activities of their respective laboratories were modified
accordingly. The laboratories in each district were supplemented by an army
laboratory which conducted the more highly technical examinations in bacte-
riology, chemistry, pathology and serology. The personnel of the army
laboratories also performed the duties of consultants in special problems,
especially surgical pathology, conducted depots of laboratory supplies and
apparatus and performed autopsies for the hospitals in their vicinity.
190
ad:ministration, American expeditionary forces
Fig. 17
ORGANIZATIOX AND ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 191
With a few isolated exceptions the work of the laboratories in the evacua-
tion hospitals would have compared favorably with that in the average civihan
general hospital, for in spite of the deterrent influences of campaign they
proved their utility — in fact their indispensability.^^ The laboratories proved
to be of immediate clinical value in both medicine and surgery and collected a
number of specimens for the Army Medical Museum.
The laboratories of mobile hospitals were especially engaged in wound
l)acteriology, for these units w^ere organized to receive the nontransportable
wounded.^- They made, however, a number of examinations in other fields,
as blood and throat cultures, differential blood counts, examinations of joint,
Fig. 18
spinal, and chest fluids, of blood, sputum, urine, urethral smears, and feces.
Serum for Wassermann tests was collected and sent to designated laboratories.
Autopsies were performed and museum specimens collected.
Some of these laboratories moved quite frequently, that with Mobile
Hospital No. 1, for example, changed station nine times in five months.^-
Some used tentage but when possible a room in a permanent or temporary
building was employed. The equipment issued was found to be ample. Many
technical expedients were employed in the eft'ort to expedite reports to the
attending surgeon. ^-
DIVISIONAL LABORATORIES
A laboratory attached to each division was staffed by two officers and
four technicians,^ who constituted a part of the staff of the division surgeon.
13901—27 13
192
ADMINISTRATION", AMERICAN' FA'PEDITIOXARY FORCKS
In close cooperation with the division sanitary inspector, tliese units were
engaged chiefly in control of epidemic diseases, in the inspection ol water
supplies, and supervision and control of water purification.^ In ert'ect they
were under the control of the sanitary inspector. The equipment issued
these units w^as packed in three chests and was not adequate for general hacteri-
ology, for it was planned that work pertaining to that specialty would he
performed in the laboratories of evacuation and mobile hospitals.^ Such nuite-
rial as was furnished for work of that character was adequate only for the
performance of routine clinical examinations.*
After the armistice began, when divisions went into training areas, many
of these laboratories requisitioned and procured additional chests to complete
Fig. 19
equipment adequate for general laboratory work, including general bacterio-
logy.^ All the divisional laboratory units with the Third Army were supplied
with complete transportable laboratory equipments, in eight chests each, thus
permitting general bacteriological and clinico-pathological w^ork.^
On July 7, 1918, in Memorandum No. 5, division of laboratories and
infectious diseases, the personnel, transportation, and duties of the divisional
laboratory unit were prescribed in some detail.^ The provisions of this circu-
lar were later republished and somew^hat amplified, in Memoranda Xos. 5 and
7 from the same office ^ (see Appendix).
These units usually were located at division headquarters, especially when
the division was in a rest or training area or at headquarters of the sanitary
train. In trench warfare or in training or rest areas the divisional laboratories
OKGAXIZATIOX AND ADMIXISTKATIOX OF CHIEF SURGEOX'S OFFIC E 193
usually occupied two rooms in some building, preferably where heat, light, and
water were available. During battle, as a rule, they were from five to seven
miles behind the front, often in open fields, by the roadside, in tents, dugouts
or unused buildings.'^ Under combat conditions it was found expedient to
divide the laboratory, the bacteriologist and sufficient personnel being located
with the bulk of the laboratory equipment at one of the field hospitals, preferably
the surgical hospital or one used for evacuation purposes.'^ This part of the
laborator}' supervised the preparation of Dakin's solution and dichloramin-T
and performed general bacteriological and pathological services. The other
part, with the water supply officer and two enlisted men with the necessary
Fk;. 20.— Showing preparations for shipi)in(; portable laboratories from the central Medical Department lahoiatory,
Dijon
equipment, tested for poisons the water supplies in advanced positions, selected
water points, and examined treated water for free chlorine.'^ Facts learned by
this party were promptly reported to the water-supply engineers, who then
supplied the personnel and equipment necessary to produce a satisfactory
drinking water. The water supply officer was charged with purification of this
water if necessary and with successive checks upon it. Chemical analyses that
icciuired the use of standard solutions presented difficulties that could hardly
be overcome in the field, but it was found expedient to test all water sources
for poison during advances. This was readily feasible.'^
Also in training or rest areas the laboratory cooperated in the location of
water sources, determined the quality of their outflow, and performed the chem-
ical and bacteriological tests incident to the control of water service.'^
194
AD:\riXISTRATIOX, AMP:K1CAX EXPP:D1T1()NAKY fokces
No hard and fast rule could be laid down for methods of procedure in
rest areas, trench or open warfare. Methods in one field were not applicable
in another, but when the division was engaged in trench warfare they were
similar to those followed when in a rest or training area. Under the latter
circumstances as much work as possible was placed on a routine basis.
Whether at the front or in training or rest area the value of these units
was clearly demonstrated, for they very materially strengthened the service of
the sanitary inspector. A case of suspected epidemic disease arising in a regi-
ment was immediately reported to the division surgeon and was sent to a field
hospital where cultures were taken and forwarded by courier to the laboratory.'^
If a diphtheria culture was found positive, contacts also were examined within
two hours. The usual routine work arising in field hospitals was handled very
readily by a courier service.'^
The success of laboratory activities was commensurate with the ability of
the unit to maintain close contact with the division surgeon and sanitary
inspector, to adapt itself to field conditions, and to make the most of the limited
facilities at hand.'^
While some of these units did admirable work and were considered indis-
pensable by some division surgeons, a large percentage were unable to function
properly under combat conditions. The principal reason for this failure was
lack of transportation. These laboratories had been included in the tentative
tables of organization formulated for the American Expeditionary Forces, and
adopted in August, 1917, but no transportation had been provided for them at
that time.' For some reason, unknown to the division of laboratories, they were
incorporated in the priority shipment schedule as "mobile laboratories" and as
Services of Supply units.' Several efforts were made to secure transportation
for these formations, and the inclusion of the personnel and their transportation
as divisional units was recommended by the director of laboratories in the proposed
revision of the Tables of Organization, when these were under consideration dur-
ing the summer of 1918. This proposed revision had not been approved on the
date of the declaration of the armistice.' Had even a motor cycle been avail-
able for each of these laboratories there is but little doubt that water discipline
would have been better throughout the division, with a consequent decrease in
the prevalence of typhoid and paratyphoid fevers and dysentery.' Lack of
transportation in a number of cases caused the elimination of these laboratories
as divisional units. '^
In January, 1919, on special request of the division of laboratories, G-4,
general headquarters, directed that one motor cycle with side car be issued to
the divisional laboratory of each division still in France. This transportation
permitted much closer and more satisfactory supervision of chlorination of
water supplies in divisional areas.'
TECHNICAL WORK OF LABORATORIES
Many types of technical laboratory work (e. g., gastric analyses, tumor
diagnoses, etc.) of peace time had little place in the laboratory service of the
American Expeditionary Forces. Instead of these, large numbers of exami-
nations of relatively few ordinary types prevailed, with occasionally a highly
specialized study to meet an emergency.*
ORGAXIZATIOX AND AD]MINISTRATION OF CHIEF SURGEON'S OFFICE 195
The officer in charge of a laboratory assisted the attending medical officer
and the surgeon by making urinalyses, blood-cell examinations, etc., and by
determining the types of bacteria in wounds/ His work was final in the diag-
nosis of many infectious diseases, and for the specific prevention and treatment
of these he cooperated in the administration of vaccines, therapeutic sera,
salvarsan, etc. He was consultant to the epidemiologist concerning the essen-
tial cause of a prevailing disease, the identification of immune carriers, and the
character and extent of water pollutions.* He inspected in large part the
chlorination work of the water-supply service and in some measure the profes-
sional work of attending medical officers by determining at autopsy any error
in diagnosis or treatment.*
The technical work of the laboratory section of the division of laboratories
was so modified by the stages of development in its organization, by the incidence
of epidemics and by active military operations that its history, for present
purposes, is divided roughly into four periods: (a) From the first landing of
troops, June 10, 1917, to November 30, 1917. Toward the latter part of this
period a large number of cases of pneumonia developed. (6) From December
1, 1917, to May 31, 1918. It was during this period that activities of the hos-
pitals of the American Expeditionary Forces began to be actively concerned
with battle casualties, (c) From June 1, 1918, to November 30, 1918, the
period of serious epidemics and of greatest battle activity, during which time
the laboratories generally were concerned largely with enteric disease, influenza,
and wounds, (d) The period of demobilization after December 1, 1918.'^
The first period, that from June 10, 1917, to November 30, 1917, was one of
tentative organization when the laboratories were engaged chiefly with the
clinical pathology and bacteriology incident to ordinary illness and to accidents
in a small body of troops in the services of supply or in training.
On August 28, 1917, the director of laboratories submitted to the chief sur-
geon, A. E. F., certain suggestions concerning autopsies, the rendition of autopsy
protocols, and the scope of the latter, and recommended that a bulletin con-
cerning these matters be issued from the chief surgeon's office. The Wasser-
mann service was begun in September, 1917.'^ In the few laboratories then
operating (4 camp hospital laboratories, 8 base hospital laboratories, and 2 sec-
tion laboratories) a small but important autopsy service was begun. Very
meager data concerning the technical laboratory work of this period are avail-
able, since no monthly reports were made.'^
In the second period, from December 1, 1917, to May 31, 1918, additional
laboratories in 12 camp hospitals, 3 evacuation hospitals, and 10 base hospitals,
as well as the central Medical Department laboratory began to function, and
the organization of the division of laboratories and infectious diseases was com-
pleted, thus greatly increasing the facilities for all types of technical work.''
Early in this period epidemics of pneumonia, diphtheria, scarlet fever, and men-
ingitis among our troops taxed these facilities to their full capacity for routine
clinical and bacteriological examinations.'^ At the end of this period the system
of monthly laboratory reports was begun, but the available information for most
of the period was quite incomplete.'^
196
ADMINISTRATION', AMKIUCAX KXI'KIJITIOXAHV FOKCES
Whoii the German offensive of May 28, 1918, in the Marne area hroufjht
relatively great numbers of American wounded into our hospitals, the Medical
Department was still very greatly undermanned in its laboratory as well as in
its other services.'^ So great was the need for medical attention that in many
organizations all laboratory officers were diverted from laboratory work to the
more direct care of the wounded. From this time until the signing of the
armistice, laboratory officers were never available in half the number necessary
to make the routine technical examinations, while research was, in general,
wholly out of the question.'^ How^ever, laboratory officers succeeded in organ-
i/>ing and developing their laboratories, in doing most of the absolutely essential
clinico-pathologic work, and in meeting emergencies, such as the performance of
large numbers of bacteriological examinations and of autopsies incident either
to battle casualties or to epidemics of enteric diseases, influenza, diphtheria,
meningitis, etc.'^ Until the 8-chest transportable laboratory units became
available, the laboratory work was accomplished with equipment relatively so
inadequate that the results obtained would have been considered practically
impossible by laboratory personnel prior to the war.'^ By November 1 the total
number of laboratories in operation had greatly increased, as shown by Table 4,
the personnel w^as advantageously distributed, and officers had learned to virtu-
ally "make bricks without straw." This third period of the laboratory activi-
ties of the American Expeditionary Forces — i. e., from June 1, 1918, to Novem-
ber 30, 1918 — stands out preeminently as an index of how much may be done
under most difficult conditions.'^
The available information concering the technical work for this period
is fairly good. In May, 1918, a standard form (No. 5) for laboratory reports
to the director of the division of laboratories had been devised and after June,
1918, this report was received monthly from most of the laboratories in opera-
tion in the American Expeditionary Forces. In October, 1918, this form was
revised and improved.'^ This monthly report, which was intended primarily
to supplement the direct supervision from the office of the director of the
division of laboratories, presented sufficient clinical information, concerning
the activities of the hospital under "data for comparison," to enable the
reviewer to determine something of the character and amount of work which
should have been done by the laboratory and the personnel available for its
accomplishment.'^ Activities were divided into six groups among the person-
nel of the laboratory. All attempts to determine the clinical incidence, as of
infectious diseases, were purposely omitted since it w^as believed that these
more properly belonged to special reports of the section of infectious diseases
and other agencies. The number of "positive" examinations in certain dis-
eases was given merely to aid the reviewer in determining whether the clinician
was underusing or overusing the laboratory.'^ For example, a very high
percentage of "positives" usually indicated underuse and a very low percentage
suggested overuse. The careful review of each report immediately upon its
receipt, and, if necessary, its return wath a critical indorsement thereon, did
much to improve the weak points in the service of some laboratories.'"^
The signing of the armistice marked the beginning of the fourth period of
activity of the laboratory service. Many of its officers who had entered from
0R(;AXTZATI0X and administration of chief SURGEON'S OFFICE 197
civil lite lofiuested orders for their return to the United States.'^ These requests
could not well be refused, though the quota of laboratory personnel was still
far below that of any other branch of the medical service.'^ The situation was
aggravated by the fact that at this very time the appearance of typhoid fever
iu a number of organizations rendered necessary extensive bacteriologic exam-
inations; thorough examinations for venereal disease were being conducted
among troops in training areas, and potential danger points, which demanded
increases of local laboratory service, were created by the concentration of
troops in embarkation camps and at base ports. Because of decreased per-
sonnel and of the increased service demanded, much of the technical service
of the laboratory division even in this final period was performed under stress.
Fortunately, however, early in this period the receipt and distribution of labora-
tory supplies had been greatly expedited and this fact, coupled with the transfer
of material from organizations being demobilized, greatly improved the physi-
cal conditions under which the service was rendered.'^
As was inevitable, not all hospitals in the American Expeditionary Forces
were staffed by attending medical or surgical officers well trained in the selection
of cases in which clinico-pathologic examinations might be of assistance; nor
were they all sufficiently trained in interpreting the results of these examinations.
In some instances serious diagnostic errors were made which might have been
prevented by even a urinalysis; in others the laboratory was called upon to
make large numbers of difficult examinations in a search for the specific cause
of a disease which was scarcely even suggested by the symptoms. Personal
supervision by medical and surgical consultants did much to improve the clini-
cal services in this respect but this was obviously inadequate to cover with
sufficient detail the activities of several hundred hospitals. In hospital centers
the assignment of the laboratory officer of the center to the headquarters staff
greatly increased the efficiency of the laboratory service of the center and
promoted its coordination with the other professional services.'^
THE CLINICO-PATHOLOGIC SERVICE
The clinico-pathologic service up to November 30, 1917, constituted the bulk
of the laboratory work, though it was far from large. During this period, there
wore few patients in hospital and, as the troops were mostly in the Services of
Suppl}^ or in training areas, clinicians were able both to study their cases care-
fully and to utilize the laboratory facilities to good advantage. Many of the
cases in hospital during this period were suffering from acute infectious diseases
of respiratory types, though true pneumonias did not reach a high rate until
December. A relatively high venereal rate which occurred in November, 1917,
made necessary many routine laboratory examinations. The laboratory records
for this period, however, are very meager, since regular monthly reports were not
then made.
The clinico-pathologic work for the second period, from December 1, 1917,
to May 31, 1918, was similar to that of the first. The epidemic of pneumonia,
beginning in the fall of 1917, gradually subsided, but a relatively large number
of patients with other diseases, particularly meningitis, scarlet fever, diphtheria,
and measles, were in hospital, and on these patients a large amount of clinico-
198
ADMIXI.STHATIOX, A:\rERICAX EXPEDITION AKY FOKCES
pathologic work of a routine character was necessary. The rehitively high
venereal rate in December, 1917, dropped materially toward the end of this
period.
The total amount of clinico-pathologic work done during the first and second
periods was low in relation to the number of cases in hospital and to the number
of both commissioned and enlisted personnel. This was due to difficulties in
providing accommodations for laboratories, to lack of equipment, to untrained
enlisted personnel, and in some instances to "overtrained" commissioned
personnel. Many of the base hospitals in the American Expeditionary Forces
w^hich first arrived in France were manned on the laboratory side, as
well as in the other professional departments by highly trained specialists.
A number of these had been concerned in their recent civil experience only with
teaching or research and a considerable period elapsed before some of them could
readjust their ideals so as to properly evaluate simple routine clinico-pathologic
examinations, such as those of urine and blood.
For the third period — i. e., from June 1, 1918, to November 30, 1918 — the
records were fairly complete, though during this period the laboratory service
being to the extent of only about 40 per cent of its normal strength, was so
greatly overworked that preparation of detailed reports was very difficult.
During the fourth period following December 1, 1918, a marked decrease
in trained laboratory personnel developed though the continuance of influenza,
the outbreak of numerous small epidemics of typhoid fever, and the more careful
venereal survey of all troops, necessitated a large amount of laboratory work.
It is not the purpose to give here numerical summaries of laboratory work,
how^ever, certain points of interest relative thereto should be mentioned.
Leucocyte counts showed a gradual monthly increase which was not
commensurate with the greatly increased number of patients in hospital, and did
not reach even an approximately proper proportion till February, 1919. This
was most noticeable in the relatively small number of differential counts made
and was probably due to failure of clinical officers to appreciate the importance
of this diagnostic procedure or their failure to insist upon the necessity for such
counts.
Malaria examinations, which reached their highest number in August, 1918,
w^ere notable for their rarity though they probably covered the necessary field
more completely than any other laboratory procedure.
Examinations of feces for parasites and ova and for entameba were
altogether too few. There was little time for these during periods of great stress
but during the fourth period they might have been more numerous. It is
unfortunately true, however, that laboratory personnel properly trained in the
technique of these examinations was seriously lacking. There was a sudden
increase in the number of examinations for intestinal parasites in August, 1918,
which continued until November of that year.
Urine examinations were fairly numerous, but their distribution and quahty
were very irregular. In many hospitals the specimens were intelligently selec-
ted, properly collected, and carefully examined. In some, this w^as not the
case. In others very few such examinations were made.'^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 199
In examinations of sputum for tubercle bacilli, as well as in those of urine,
relaxation in thoroughness w as prone to occur. Specimens which the labora-
tory officer knew were not intelligently selected or collected were apt to be
superficially examined, thus rendering negative reports of little value. In
some hospitals as many as four or five hundred specimens were examined
with only four or five "positives" reported. It is true that these were intended
as controls in cases of recovery from influenza and pneumonia, but it was
suspected that in many instances the lack of care in the collection of sputum
and the hasty search for bacilli made the negative findings of relatively little
value. The number of examinations of sputum for tubercle bacilli gradually
increased reaching their highest point in January, 1919.^^
The number of examinations for gastric contents was relatively small
in comparison with such as would have been necessary for an equal number
of patients in civil hospitals. Most of the military patients being young,
robust, and subject only to wounds and acute diseases, there was little neces-
sity for the examination of gastric contents with a view of reaching a diagnosis
of gastric ulcer or cancer.'^
In addition to the chemical laboratory tests which were made in most
suspected cases of this character, great reliance was placed upon roentgenology.'^
The occurrence of sporadic cases of true epidemic meningitis at widely
separated points in the American Expeditionary Forces, kept the whole Medical
Department on the alert. While it can not be demonstrated beyond per-
ad venture that had no measures been taken, serious epidemics of meningitis
would have developed, yet it is probable that the early accurate diagnosis
and the vigorous methods instituted in most instances immediately on the
development of a single case, served in large measure to prevent epidemics.'^
In this service the laboratory officer rendered inestimable assistance to the
attending medical officer.'^
Smears for gonococci showed a gradual monthly increase though not
reaching a considerable proportion until February, 1919.'^
Dark field examinations for Treponema 'pallida were considerably though
not sufficiently increased after the armistice began. It was difficult to find
enough officers to make the large number of necessary dark field examinations
in a competent manner.'^
Except in the few instances noted above, the general quahty of the clinico-
pathologic examinations was good. A large number of clinicians had been
trained in civil practice to expect and more or less intelligently to interpret
these examinations. This counteracted the tendency on the part of some
laboratory officers to relegate this work to untrained personnel.''^
Up to November 30, 1917, very few post-mortems were made in the American
Expeditionary Forces. The chnical service before that date was very light,
the attending medical officers and surgeons had time to study their cases
with great care, and thus the necessity for a post-mortem examination of
tlie few cases that died was not very apparent.'^ Of the post-mortems that
were made, the records either were incomplete or in some instances lost,
so that but 14 protocols for this period — representing about one-fourth of
the deaths — were received in the offices of the director of the division of lab-
200
ADMIXISTEATION, AMKRICAX KXJ'KDITIOXAKV FOHCES
oratories. Most of these autopsies were made at Army laboratory Xo. 1,
Naval Base Hospital No. 1, and Camp Hospital No. 33.'"
During the period from December 1, 1917, to May 31, 1918, the number
of autopsies increased in May to 57 per cent of the total number of deaths
in hospital. This was due in part to the fact that on April 2 Circular No. 17,
(q. V. in the Appendix) was issued from the chief surgeon's office.'^
By the end of May, 1918, there were in the American Expeditionary
Forces laboratories serving 25 base hospitals, 8 evacuation hospitals, 32 camp
hospitals, 4 Red Cross hospitals, and 1 mobile hospital, besides Army lab-
oratory No. 1, the central Medical Department laboratory, and the base
laboratory of the intermediate section, or a total of 70 hospitals and 72
laboratories, in addition to those pertaining to divisions.'^
Less than 15 pathologists in the American Expeditionary Forces were then
capable of making post mortems and intelligently interpreting the results.
This condition was due in part to the long neglect of the autopsy service in
many civil institutions in the United States with inevitable reduction in the
number of pathologists, and in part to the overshadowing status of bacteriology
in military laboratories.^^ The autopsy service had not been established as a
routine procedure in the xVrmy but on the contrary, autopsies were made only
on the written authority of the commanding officer of a hospital. However,
in the American Expeditionary Forces the need of a routine autopsy service
amounting in fact to a professional inspection of the diagnostic and thera-
peutic measures of officers engaged in clinical service, rapidly became apparent
during the summer of 1918. Surgeons were called upon with little time for
study or reflection to diagnose and treat enormous numbers of gunshot wounds
with which they had had little or no previous experience. Even those who
were well grounded in the general principles of surgery were forced to make
decisions and institute treatment thereon without sufficient opportunity for
study. As a result, there were many errors in diagnosis and corresponding
errors in treatment. The worst of these could be determined only by the
pathologist. Likewise, medical officers attending cases of gas poisoning,
influenza, and pneumonia were confronted by conditions with which they
were totally unfamiliar, and frequently were forced to make diagnoses and to
institute treatment with a very meager knowledge of the facts. Here autop-
sies proved of tremendous importance for they afforded knowledge of patho-
logic 'lesions which the physicians treating the case could use in their subse-
quent diagnoses and treatment. When, in the fall of 1918, and in the follow-
ing winter, numerous isolated epidemics of typhoid fever began to appear,
the symptons and physical signs, in many instances, were so obscure that the
clinicians failed to make proper diagnoses and the pathologist was the first
to recognize the true nature of the disease on the autopsy table.
The director of the division of laboratories, in June, 1918, requested that
10 competent pathologists be cabled for from the United States, in addition
to those coming over with hospital organizations.'^ These 10 pathologists
arrived in due time and assisted materially in improving this service. The
activities in forward areas were now covered to better advantage bv dividing
the territory into sectors and placing at Baccarat, Toul, Souilly, and Paris,
OHGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 201
respoctivoly, coinpetent pathologists attached to an evacuation or base hospi-
tal, with orders to act as consultants in their specialty for the surrounding
areas. '•'^ In addition to these measures, the importance of autopsies was
brought to the attention of laboratory officers and commanding officers of
hospital organizations by inspectors from the division of laboratories, by
letters, and by indorsements on monthly reports. As a result, the autopsy
service rapidly improved, though there were never sufficient competent pathol-
ogists in the American Expeditionary Forces to cover the needs at all points.
There were not more than 50 or 60 pathologists among the 685 medical officers
in the laboratory service when the armistice was signed, but the service had
so increased during the summer and early fall of 1918, that autopsies were
performed on 95 per cent of all deaths in hospital. In October the total number
of autopsies reached 8,896.'^ This was but 85 per cent of the deaths then
occurring in hospitals for the autopsy service like every other was overwhelmed
by the enormous number of deaths from influenza and by the battle casualties
of the Meuse-Argonne operation.
The greatest nuinber of deaths occurred in the base hospitals. After
July, 1918, many more autopsies were done in camp hospitals than in evacua-
tion and mobile hospitals for they not only were more numerous but many of
them actually functioned as base hospitals. An attempt was made to study
hattle casualties, particularly gas poisoning, by centrally located laboratory
officers who could be concentrated by the use of motor transportation at any
point where casualties occurred. This plan, which was then employed in the
i^'rench service, usually failed because of lack of transportation.'^
Pearly in July the recording and cross indexing of autopsy protocols was
l)egun in the office of the director of division of laboratories, but inadequate
assistance rendered progress in this direction very slow.'^
After the signing of the armistice, the release from duty elsewhere of a few
competent pathologists made it possible to place the analysis of the autopsy
protocols concerning a few diseases, on a better basis. In order to facilitate
this work in the central laboratory and to obtain the benefit of the review
by the competent pathologists scattered throughout the American Expe-
ditionary Forces, three office letters concerning, respectively, influenza and
pneumonia, gunshot injuries, and war-gas poisoning w^ere sent out to laboratory
officers selected because of their ability and experience.'^ These office letters
gave forms for the analysis by the laboratory officer of all cases coming to
autopsy under his individual observation. On the receipt of these analyses
in the office of the director of laboratories they were compiled and coordinated
with one another and with scattered protocols from other laboratories. Two
other compilations were undertaken, one on typhoid fever and another on
tuberculosis. In addition to these, however, the other autopsy protocols con-
tained a wealth of data for further study on a number of subjects; e. g., men-
ingitis, dysenteries, and cardiovascular lesions.'^
One field of post-mortem examinations which might have yielded invaluable
results from the purely military standpoint was entered by but one pathologist
in tiie American Expeditionary Forces. This was the examinations of the
hodies of soldiers killed in battle.'^ This service did not necessitate the making
202
ad:mixistratiox, American expeditionary forces
of autopsies, but was limited to a study of the site and character of iinnieduitely
fatal injuries by a medical officer who had a good knowledge of anatomy and
some appreciation of the character and effects of missiles.'^
KEFERENCES
(1) Report from Col. J. F. Siler, M. C, director of laboratories and infectious diseases,
A. E. F., to chief surgeon, A. E. F. (undated), on the activities of division of labora-
tories and infectious diseases, from August, 1917, to July, 1919. On file. Historical
Division, S. G. O.
(2) Report on the Medical Department activities of base section No. 5, A. E. F., undatefl,
made by the surgeon, base section No. 5. On file. Historical Division, S. G. O.
(3) Report on the Medical Department activities of Camp Hospital No. 33, by First Lieut.
George R. Cowgill, S. C. On file. Historical Division, S. G. O.
(4) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file. Historical Division, S. G. O.
(5) Report on the laboratory service of hospital centers in converted permanent buildings,
undated, by Maj. Harrison S. Maitland, M. C. On file. Historical Division, S. G. 0.
(6) Report of hospital center at Mesves, undated, prepared under the supervision of the
commanding officer of the center (not dated or signed). On file, Historical Division,
S. G. O.
(7) Report on the activities of the laboratory. Base Hospital No. 27, A. E. F., January 20,
1919, by the officer in charge of the laboratory. On file. Historical Division, S. G. 0.
(8) Report of laboratory of Camp Hospital No. 15, A. E. F., April 1, 1919, by Capt. M. L.
Holm, M. C. On file. Historical Division, S. G. O.
(9) Report on the laboratory situation in Third Army, by Lieut. Col. W. M. L. Copliii,
M. C, March 18, 1919. On file. Historical Division, S. G. O.
(10) Report on mobile laboratories, A. E. F., undated, by Capt. C. O. Rinder, M. C. On
file. Historical Division, S. G. O.
(11) Report on the laboratory service of the evacuation hospital, January 3, 1920, by Maj.
Arthur U. Desjardine, M. C. On file, Historical Division, S. G. O.
(12) Report on the laboratory work of Mobile Hospital No. 1, A. E. F., by Capt. A. A.
Johnson, M. C, officer in charge of laboratory, January 1, 1919. On file. Historical
Division, S. G. O.
(13) Report on the laboratory work of Mobile Hospital No. 39, January 2, 1919, by First
Lieut. William S. Keister, M. C. On file, Historical Division, S. G. O.
(14) Report on the laboratory service of divisional laboratories, A. E. F., undated, by Capt .
Lucius A. Fritze, M. C. On file. Historical Division, S. G. O.
(15) Report on the pathological service, division of sanitation and inspection, American
Expeditionary Forces, undated, by Colonel Louis B. Wilson, M. C. On file. His-
torical Division, S. G. O.
(16) Letter from directer of U. S. Army Laboratory No. 1, to the chief surgeon, A. E. F.,
August 28, 1917. Subject: Post-mortem examinations. On file, A. G. O., World
War Division, chief surgeon's files (321.630).
CHAPTER XIT
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
SECTION OF INFECTIOUS DISEASES; SECTION OF WOUND BACTERIOLOGY
SECTION OF INFECTIOUS DISEASES
In November, 1917, the director of laboratories planned the organization
of a subdivision to be called the "subdivision of infectious diseases." It was
proposed that this work be placed under the direction of an assistant director
of laboratories, who should act as general advisor to the chief surgeon, A. E. F.,
in all matters pertaining to communicable disease.^ The officer assigned to
this position on December 1, 1917,- had begun the organization and formula-
tion of plans of procedure when, in the following month, he was assigned to
the trench fever commission. Thereafter, until midsummer of 1918, he was
unable to take an active part in the subdivision of infectious diseases, but being
frequently consulted by letter and by personal interview, offered many helpful
suggestions.^ In February, 1918, another officer was appointed assistant
director in charge of the section of infectious diseases, and with the cooperation
of the first incumbent, perfected the organization of the section.^
FUNCTIONS
The functions of this section were outlined as follows : ^
The function of the subdivision of infectious diseases is to provide an instrument for
tlie prompt epidemiological and bacteriological investigation of transmissible diseases among
troops of the American Expeditionary Forces. It constitutes, therefore, direct liaison
between the division of sanitation and inspection and the laboratories, and is grouped with
the latter only because its activities require the occasional mobilization of laboratory facili-
ties and because its personnel should be capable of directing on the spot any laboratory
work which the thorough study of any given situation may require. While operating from
the laboratories as bases, therefore, this subdivision constitutes actually a part of the machin-
ery of sanitation.
The duties of the subdivision of infectious diseases consist in:
1. Epidemiological and laboratory studies of outbreaks of transmissible diseases in the
American Expeditionary Forces, having as primary purposes the discovery of source of out-
break, its mode of dissemination, and its control.
2. The study and organization of new prophylactic measures.
3. The investigation of special problems which may arise in connection with the control
of epidemics.
4. The inspection of laboratories in so far as their diagnostic work, carrier examination,
and epidemiological work are concerned.
5. The organization of mobile laboratories for epidemiological work in base sections.
6. The preparation of circulars and literature concerning infectious disease for submission
to the chief of the division of sanitation and inspection, laboratory, and infectious diseases.
7. Advisory cooperation with the various sanitary and medical authorites in the hospi-
talization and isolation of infectious diseases.
Organization. — There will be a central office of this subdivision at the central Medical
Department laboratories, A. P. O. No. 721, American Expeditionary Forces, which will be in
cliarge of officers delegated to this work by the director of laboratories.
203
204
ADMIN ISTHATIO.V. AMKHICAX KXI'EI)IT1()^ AK^' FOHCK.S
The activities of this office will iiichicle:
(a) The selection of personnel to carry on tiio work of the sul)(li\ i>i()ii.
(h) The supervision of the work of tliis personnel w lienever necessary in a given oiit-
lireak.
(c) Periodical inspection of the laboratories of the front area in regard to their work on
infectious diseases, and similar inspect on of other laboratories of the American Expeditionary
Forces when so instructed by the director of laboratories.
{d) The maintenance at the central medical laboratories of records of the activities uf
this subdivision.
(e) The study of special problems tliat may arise in connection with transmissible disea.M'.
(/) In the advance section and zone of the advance, the officers assigned to the work will
keep in constant touch with the incidence of infectious disease and personally investigate any
focus which seems to them or to local authorities to call for investigation. They will personally
undertake similar investigations in the base sections when instructed to do so.
There will be assigned to the base laboratory in each base area and to each army labora-
tory an officer who is ready to carry out similar work in his respective area at the direction of
the division of sanitation, inspection, laboratories, and infectious diseases. He wall be ready
to proceed to any point in the base section when notified by the chief surgeon of the section
to do so. His orders will come through the commanding officer of the base laboratory to whom
he will be responsible for the proper performance of the laboratory work and the return of the
property he may take with him. He will take with him from the base laboratory a mobile
laboratory car or any material and personnel he may lequire for the particular work to b(
done. If, in the opinion of the authorities concerned, any situation becomes sufficient!}
grave to require advisory cooperation of the officers in charge of infectious diseases at tlu
central medical laboratories, a telegraphic request will be made on the central medical labora-
tory and the director of laboritories will send one of the officers in charge of the sul)division
of infectious diseases to the point where advice is needed.
In the advance section and zone of the advance similar liersonnel will be assigned for
similar purposes to the Army laboratories. But in addition to this, these areas being directly
accessible to the central medical laboratories, the officers assigned as assistant directors for
infectious diseases will keep in constant touch with infectious disease occurring in these areas
and proceed without further orders to any point where infectious disease is reported, in
order to investigate whether further study, segregation, etc., is needed.
Suggested mode of procedure. — When the occurrence of cases seems to call for the detailed
study of local conditions, orders will be issued to the officer stationed at the respective base
laboratory who will proceed to the station indicated. On arrival, he will report, to the local
chief surgeon and will familiarize himself with local laboratory facilities and arrange cooper-
ation with local laboratory personnel. He will consult local sanitary officers and obtain a
careful liistory of the outbreak from its beginning, will visit commands and quarters from
which cases have been taken, make spot maps of occurrence, trace contacts, and investigate
relations of case to case. He will study relations of outbreak to w^ater and food supply and
will proceed to organize and carry out any laboratory work or serum tests necessary to eluci-
date the situation and control the disease.
In consultation with local medical authorities he will inaugurate sanitary measures
aimed at control of the disease and on completion of the work will submit a report, incor-
porating specific recommendations. A duplicate copy of this will he sent to the chief of the
division of sanitation and inspection, laboratories, and infectious diseases. One copy will
l;e left with local chief surgeon, and one will be retained as a record of the subdivision of
infectious diseases.
In the advance section and zone of the advance, the officers in charge of the subdivision
of infectious diseases will supplement this system by visiting as promptly as possible all
locations where infectious disease is occurring, and determine by personal investigation whether
the situation requires special study.
The duties of this section as finally prescribed were published in Circular
No. 40, chief surgeon's office, July 20, 1918. (See Appendix, p. 958.)
ORGANIZATION AND AUIM INISTEATION OF CHIEF SUEGEON'S OFFICE 205
It was not proposed that this section would engage in research, except in
so far as the study and suppression of outbrealvs of disease necessitated. Its
primary purpose was the early discovery of foci of infection, the prompt tracing
of cases to the point of their infection, and the suppression of diseases traced in
this manner before they could reach epidemic proportions.^
Though the foregoing plans had been formulated for the development of
this section of the director's office, no personnel was at first available to carry
these into effect.* Such outbreaks of epidemic diseases as did occur were in-
vestigated by field parties sent out from Army laboratory No. 1 at Neufchateau.*
Only four divisions were in France at the end of December, 1917, and the only
epidemic diseases requiring investigation by this section were small outbreaks
of meningitis, diphtheria, scarlet fever, influenza, and pneumonia.* Water sup-
])ly surveys were carried out in very considerable portion of the then existing
divisional training areas by field parties from Army laboratorj^ No. 1, and it
became evident, from these early surveys, that approximateh^ 85 per cent of
the water for drinking purposes was contaminated. This initial estimate of
the water-supply situation in France was confirmed by surveys at a later date.*
All matters relating to transmissible disease were referred to the section
of infectious diseases, for it was concerned mainly in the investigation of epi-
demics, development of the organization for their control and prevention
throughout the American Expeditionary Forces, the preparation of bulletins
relating to prevention and control of transmissible diseases, the standardization
of methods for combating them, and standardization of the use of therapeutic
sera which were of value in this w^ork.* Reserve personnel for the investigation
of epidemics was attached to the central Medical Department laboratory at
Dijon, and most of the investigations of epidemics conducted under the control
of the director of laboratories and infectious diseases w^ere prosecuted in coopera-
tion with and under the direct supervision of the commanding officer, central
Medical Department laboratory.* The duties assigned to the division of labora-
tories and infectious diseases by Circular No. 40, chief surgeon's office, and the
memorandum quoted above, indicate how closely the central laboratory and
the section of infectious diseases were associated.* In April, 1918, preliminary
steps were taken to coordinate the central office of the section of infectious
diseases with those engaged in similar service in the several administrative sec-
tions of the Services of Supply.*
Because of rapidity with which American troops arrived and of the large
territory over which they were distributed, decentralization of the epidemiolog-
ical service became necessary for proper supervision and prompt action.^ In
the original plan it had been contemplated that a standard uniform method of
control throughout the American Expeditionary Forces would be adopted and
that a selected and trained officer qualified to make epidemiologic and bacteri-
ologic studies of outbreaks of infectious diseases w^ould be stationed in every
section of the Services of Supply. Each section epidemiologist was to have
available a main laboratory adequately equipped for the performance of any
diagnostic or other laboratory work. It was expected that this officer ordi-
narily would handle problems arising in his section but that in emergencies he
would obtain extra personnel and equipment from the director of laboratories
206
ADMINISTRATION, A^[ERK'AN EXPEDITIONARY FORCES
and infectious diseases.^ Later, after conferences with medical representatives
from the various administrative sections of the Services of Supply, and after
receipt of their replies to a circular letter sent them concerning the adoj)tion
of methods for control of infectious diseases, a somewhat different plan for the
organization of epidemiologic service in these sections was formulated.' This
plan, which was generally adopted, with some variations to meet particular
local problems, provided that the several sections of the Services of Supply
would solve their respective problems.' However, in each section an epidemi-
ological service with laboratory facilities was established, and though each such
epidemiological service operated more or less independently of the central
administration of the division of laboratories and infectious diseases, it called
upon the central laboratory for advice, personnel, and material, w^henevcr
needed, and was in constant communication with it.'
Also it had been planned that in the advance section and zone of the armies
the epidemiologic w^ork would be centralized at the office of the director of labora-
tories and infectious diseases, that through the office of the respective chief
surgeon, the director would be kept constantly informed concerning the inci-
dence and location of infectious diseases, and that he would have sufficient
personnel and mobile laboratory equipment immediately to give assistance
where necessary.^ In point of fact the control of infectious diseases among
troops in the army zone remained under the direct supervision of the director
of laboratories until the later summer months of 1918.'
Arrangements for the prevention and control of epidemics among the troops
in the zone of the armies utilized and expanded resources and methods already
provided by Tables of Organization.^ The division sanitary inspector, as assist-
ant to the division surgeon was, as theretofore, primarily responsible for the
health of the division. He attended to all ordinary matters affecting sanita-
tion in which duty he was assisted by two officers previously not provided in
our service, viz, the laboratory and water supply officers.^ The divisional
laboratory officer w^as in charge of a small laboratory equipped for clinical pathol-
ogy but inadequate for extensive cultural work; the divisional sanitary
inspector of water, who had had some training in general bacteriology, per-
formed examination of water supplies.^ As soon as resources of personnel
permitted, these officers, intended for these positions, were given an intensive
course of training at the central laboratory at Dijon, before they were assigned
to divisions.^
Some divisions came to France without laboratory officers, but they were
furnished them after arrival from personnel assembled and equipped by the
section of infectious diseases.'
It was intended that the divisional laboratory officer should act not only
as a technical laboratory worker for the division but should assist, the sanitary
inspector in making epidemiologic surveys and sanitary inspections.' It may
be said, in passing, that in many cases this could not be effected because of the
lack of transportation.' This divisional organization was cjuite adequate
under ordinary circumstances to deal with conditions that threatened the
health of the troops, but because of insufficient laboratory equipment and
shortage of personnel, it was necessary in any considerable outbreak of com-
municable disease to send reenforcements.'
ORGANIZATION AND ADMINISTEATIOX OF CHIEF SURGEON'S OFFICE 207
The duties of the division sanitary inspector of water were reduced to their
simplest forms. He supervised the chlorination of drinking water in the division,
gave appropriate instructions, kept in touch with any water problems that
arose, and constantly reported concerning the purification apparatus available.^
Laboratories adequately equipped for the examination of all water supplies
were not available for issue to the divisions.^
Because of insufficient personnel and laboratory equipment in a division
wherewith to combat epidemics, Bulletin No. 32, G. H. Q., A. E. F., May 27,
1918, was issued, which provided that such resources could promptly be aug-
mented whether troops were in the lines or in training areas. This bulletin
authorized an army or division surgeon to communicate in emergencies directly
with the director of laboratories and to request assistance; the director of
laboratories was authorized to send such personnel and equipment as might be
necessary, and to cooperate to the extent of his resources.
The section of infectious diseases was active throughout the advance
section and assisted in the control of outbreaks of diphtheria, scarlet fever,
measles, meningitis, influenza, and diarrhea, employing in this service additional
laboratory personnel and equipment; e. g. mobile laboratory cars, constructed
and completely equipped according to the English plan (with some modifica-
tions) for the investigation of such epidemics as might arise. ^ Usually they
were manned by one commissioned officer, a driver and a technician, dispatched
on telegraphic requests either from the central Medical Department laboratory
at Dijon or from Army laboratory No. 1, at Neufchateau (where one of these
cars was stationed), according to the area from which the request was received.^
Sometimes the local laboratories of base or evacuation hospitals were utilized,
and additional resources were dispatched in response to telegrams to the director
of laboratories at Dijon. ^
To further meet the requirements of field investigations of outbreaks of
epidemic disease the laboratory service began, about April, 1918, to assign to
duty at the central Medical Department laboratory special, well-trained medi-
cal officers whose primary duty was the direction of field parties engaged in the
investigation of epidemics."^ Usually there were from two to four such officers
engaged in activities of this character. There were also mobilized at the
central laboratory for use by these parties several special laboratory units
consisting of equipment packed in chests and two of the motor laboratories
mentioned above.*
Laboratory methods securing early diagnosis, detection of carriers, and
practical measures of control of infectious diseases were standardized and put
into general operation.^
In July, 1918, American troops actively engaged in the Chateau-Thierry
sector suffered very extensively from diarrheas and dysenteries.^ During the
period from July to November, 1918, the activities of this section were greatly
decentralized so that by November its functions were mainly those of adviser
to the chief surgeon's office in general policies relating to the prevention and
control of transmissible diseases.*
13901—27 14
208
ADMINISTRATION, AMERICAN EXPP:DITIC)NAR V FC)Rr?:S
Meanwhile decentralization had continued so that tlie several adminis-
trative sections of the Services of Supply were relatively independent of centnil
supervision and in each a special base laboratory had been established.'
As American troops concentrated in the advance section and in the zone
of the Army, and more and more divisions began to participate actively in
combat, other daughter organizations w^ere split off from the central office of
the section of infectious diseases, to serve the several corps or armies.' It was
decided, as the result of experiment, that these organizations should belonfr
to armies rather than to corps.' Therefore a sanitary inspector was assigned
to the Second Army and a system similar to that in the administrative sections
of the Services of Supply w^as put in operation but modified to suit moving
troops. In consequence, the sanitary organization of an army also became
largely independent, (except for personnel and laboratory supplies) of the
central office.' When the Third Army was organized, for the occupation of
the American sector on the Rhine, a sanitary division was created, as part
of the office of the army surgeon.' The duties of the section of infectious
diseases in so far as the Third Army was concerned, pertained especially to
coordination, supervision, inspection, advice, and provision of personnel and
equipment.'
As a result of this sectional organization, with trained men in definite areas
or assigned to service of bodies of troops, and the aid of mobile laboratories, it
w^as possible to render prompt assistance, make surveys for carriers, correct
sanitary defects, and materially aid in the prevention and suppression of epi-
demics.^ Numerous investigations w^ere made of outbreaks of measles, menin-
gitis, influenza, pneumonia, diarrhea and dysentery, typhoid and paratyphoid
fevers, scarlet fever, diphtheria, and similar diseases. The sources w^ere sought
out and recommendations for their control made.
Concurrent with the development of its field service the section of infectious
diseases prepared circulars pertaining to control of infectious disease, and con-
ducted instructional work.' This latter activity which at first was limited to
consultations with laboratory officers intended for assignment to divisions,
developed into a course of instruction in carrier investigation and other technique
needed in field work concerning communicable diseases and the supervision of
drinking water.'
When the armies had been organized with epidemiological facilities this
service, for all the larger units of the American Expeditionary Forces, had become
decentralized.' Thereafter the duties of the section of infectious diseases were
more of a supervisory and advisory character than those of actual participation
in the solution of problems, as they had been formerly.'
The section of infectious diseases continued to act as adviser of the chief
surgeon, A. E. F., in the formulation of broad policies of sanitation, and in the
circularization of information relative thereto, until it was abolished.' Its
activities were absorbed into the chief surgeon's office after headquarters of the
division of laboratories moved to Tours in June of 1919.'
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 209
SECTION OF WOUND BACTERIOLOGY
After a study of bacteriologic investigation of war wounds as conducted by
our allies, and a survey of the organization employed for this purpose, at La Panne,
liouieuse, Epernay, and Chalons, a section charged with the supervision and
correlation of such work in the American Expeditionary Forces was established
in the division of laboratories in March, 1918. Its purpose was to be the dis-
semination of information on this subject and the determination of the circum-
stances under which a delayed primary or secondary suture of a wound might
best be performed. Secondary and delayed primary closure were being practiced
among our allies only after laboratory findings indicated the advisability of
such practice and the provision of personnel and equipment for obtaining similar
findings in the American Expeditionary Forces was deemed advisable.^
The scientific value of the examination of war wounds was subordinated to
practical needs in the organization of this section, for few statistical data appar-
ently were being collected by the laboratories of our allies where research work
was being conducted. The prime services rendered by this section were assist-
ance to surgeons who had not had much experience in treatment of war wounds,
the provision of a control which would complement professional acumen of the
more experienced surgeons, and, in time of stress, would relieve them of making
close studies which otherwise would have been necessitated clinically.®
It was planned that a trained wound bacteriologist and an assistant would
be assigned to each mobile, evacuation, and base hospital, and that this person-
nel would be increased as resources in general laboratory personnel permitted.
This additional personnel was to be organized in teams which were to be trans-
ferred as required. The entire service of wound bacteriology was to be under
tiie control of an assistant to the director of laboratories, who was to provide,
train, and distribute these specialists, supervise their activities and conduct
appropriate research.® It was planned that a statistical bureau would collect
(hita concerning the bacteriology of war wounds from all hospitals in the
American Expeditionary Forces and that an agency which would distribute
literature on this subject would also be established. Studies at the central
hiboratory were to supplement those in the several hospitals and the central
laboratory was to prepare and distribute media and reagents both in order
to lessen the work of the laboratories at the front and in order to standardize
materials. Such research as was to be conducted was to be of immediate
practical value.®
But these plans did not fully materialize: The paucity of officers did not
permit the formation of teams as planned; lack of transportation prevented the
central laboratory renewing prepared media, ingredients for media being sub-
stituted therefore.
Oflicers who, in their replies to a questionnaire, were found to have the
necessary training in general bacteriology were ordered to the central laboratory
at Dijon where they were given an intensive course in wound bacteriology. This
c()nii)rised laboratory instruction, autopsy demonstrations, and a certain
amount of training at the bedside. Classes consisted of about 20 officers, whose
course of training lasted two weeks. The number instructed at the central
Medical Department laboratory totaled 134.®
210
ADMINISTRATION, AMERICAN KXPEDITIONARY FORCES
A few officers were trained at other points, viz, 7 at Epernay, 0 at Aut(j-
chir No. 21, 7 at Evacuation Hospital No. 1, and 4 in hospitals belonging to
the Allies. When the armistice was signed, officers trained in wound bacteri-
ology were assigned to all evacuation, mobile and base hospitals except the most
recent arrivals and a few of the hospitals serving at hospital centers. The
number of wound bacteriologists thus assigned were as follows:'' Evacuation
hospitals, 16; mobile hospitals, 13; Red Cross military hospitals, 10: base
hospitals operating separately, 18; base hospitals in hospital centers, 66.
Though there was inadequate time to work it out, the plan was to provide
one officer trained in wound bacteriology for each 500 surgical beds and recall
from time to time officers already instructed to receive further instruction in
newer methods and to discuss their several problems, administrative and
professional.^
The most difficult problem experienced by this section was the preparation
of records and the collection of statistical and other data. Two blank forms
were devised, one relatively very brief for use in periods of stress, the other
more thorough, to be used in periods of relative quiet, but only a relatively
small number of organizations found it possible to collect fairly complete
records.^
A monthly statistical report form was also called for but this wag utilized
by only a small number of organizations. These units, however, went far
toward collecting the information desired.*'
Special investigations concerning gas gangrene, the use of antigas gan-
grene and antitetanic sera, and the possible infection of wounds by attendants
were undertaken. Research seeking the recovery and identification of organ-
isms concerned in wound infection and the value of certain smears and indi-
cators was also undertaken at the central laboratory.*'
On October 29, 1918, the head of this service reported as follows to the
director of laboratories : ^
At present the central organization of the section of wound bacteriology is still under-
manned. While an adequate number (considering the number of laboratory officers in the
American Expeditionary Forces and the needs of other sections of this division) of wound
bacteriologists for service in the field is now available, the administrative force in the central
office is inadequate properly to control the work of the officers in the field, to analyze and
arrange the statistical evidence which is rapidly accumulating, and finally to verify the
identification of bacterial species recovered from important cases.
The most important single need of this section is an officer with consideraljle laboratory
experience whose duty it will be to make frequent inspections of all the laboratory units
engaged in the bacteriologic study of war wounds with a view of determining the efiiciency
of the workers in this field, of raising the standards of the work done by correcting obvious
defects and stimulating enthusiasms for this particular work, both among the laboratory
officers and among those engaged in the surgical care of the wounded, and finally of collect-
ing data which might serve as a basis for the improvement of the service. The rapid
increase in the number of hospital organizations in the American Expeditionary Forces and
the extent of the area which they occupy makes such additional assistance necessary.
Two additional officers to conduct research concerning the bacteria found
in wounds, an officer to analyze reports received, and two file and record clerks
for headquarters were also required. These needs were obviated by the
declaration of the armistice on November 11 and the section as such sub-
mitted its final comprehensive report on December 4, 1918.^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 211
REFERENCES
(Ij Report on general plan, organization, and development of the section of communicable
diseases, A. E. F. (undated), by Lieut. Col. Hans Zinsser, M. C. On file, Hi.storical
Division, S. G. O.
(2j Letter from The Adjutant General of the Armj- to Lieut. Col. Richard P. Strong, C,
December 1, 1917. Subject: Appointment as assistant director of laboratories. On
file, A. G. O., World War Division, chief surgeon's files, 201 (Strong, Richard P.).
(3) Report on division of laboratories and infectious diseases, subdivision of infectious dis-
eases, A. E. F. (undated), by Lieut. Col. Hans Zinsser, M. C. On file, Hi.storical
Division, S. G. O.
(4) Report from Col. J. F. Siler, director of the division of laboratories and infectious dis-
eases, to the chief surgeon, A. E. F. (undated). Subject: Activities of the division
of laboratories and infectious diseases, from August, 1917, to Juh', 1919. On file,
Historical Division, S. G. O.
(5) Report from the chief surgeon, A. E. F., to The Surgeon General, L^. S. Army, May 1,
1919. Subject: Activities of thechief surgeon's office, A. E. F., to May 1,1919.. On
file, Historical Division, S. G. O.
<6j Report on the section of wound bacteriology, A. E. F., December 4, 1918, by Lieut.
Col. William J. Elser, M. C. On file, Historical Division, S. G. O.
CHAPTER XIII
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
SECTION OF WATER SUPPLIES; SECTION OF FOOD AND NUTRITION; MUSEUM
AND ART SECTION; LABORATORY OF SURGICAL RESEARCH
SECTION OF WATER SUPPLIES
The entire question of water supply and purification in the American
Expeditionary Forces is dealt with in Volume VI of this history. Therein
i-cference is made to the fact that stationary laboratories were established in the
Services of Supply, A. E. F., for water analysis in certain Medical Department
genei"al laboratories. One of these laboratories was the central Medical Depart-
niont laboratory at Dijon. ^
In addition to water analysis, a subject which is outside the scope of the
I)resent chapter, the necessity existed for supervising water supply activities in
the zone of the advance, not otherwise cared for by the water supply service,
A. E. F. This supervision centered in the central Medical Department labora-
tory at Dijon. Until the latter part of September, 1918 (except for a short
period that is referred to below), the water supply activities of the division of
laboratories were supervised by the section of infectious diseases.^ It was
during May, 1918, that efforts were made to organize a definite section in the
central laboratory for coordinating water supply. Such a section was estab-
lished and charged with the coordination of Medical Department activities
pertaining to water supplies in the zone of the advance. However, since the
officer then assigned to the section was retained therein only a short time, it
was not until the following early fall that water supply work of the Medical
Department in the zone of the advance was definitely coordinated.^
On September 27, 1918, an officer of the Sanitary Corps, expert as regards
water supply and analysis, was assigned to organize a section of the central
laboratory having to do with control of such water supplies in the zone of the
advance as come within the province of the Medical Department.^ Thereafter,
that section was engaged in the supervision of water surveys in all training
areas in the Advance Section, the assignment of proper Medical Department
personnel, the instruction of divisional personnel in water survey work, including
control of chlorination of water supplies, and coordination with the officer in
charge of the laboratories in the water supply service.^ The chief of the water
supply section in the division of laboratories and infectious diseases was the
representative of the Medical Department, in its liaison with the water supply
service, A. E. F. made; plans pertaining to Medical Department activities con-
nected therewith, and distributed the laboratory facilities which were made
available for water analyses.-
214
ADMINISTRATION, AMERICAN EXPEDITIONARY FOHCES
SECTION OF FOOD AND NUTRITION
In August, 1917, there was organized in the Office of the Surgeon General
a division of food and nutrition, whose officers were authorized by the Secre-
tary of War on October 16, 1917, to inspect food supplies in camps, to endeavor
to improve the mess conditions, and to study the suitability of the ration and
the food requirements of the troops. Officers of this division were sent to camps
in the United States where they gave instruction to cooks, mess officers, and
unit commanders and also made extensive studies of ration suitability and
requirement.^
On January 18, 1918, the chief surgeon, A. E. F., requested that suitable
officers be sent to France for similar services in the American Expeditionary
Forces,* and one month later the commander in chief, A. E. F., made the same
request by cable. ^ Accordingly, six officers were selected for this purpose and
on March 1, the Surgeon General wrote the chief surgeon, A. E. F., that they
would report for service after having studied food conditions in England."
The Surgeon General outlined the nature of the services these officers
already had rendered and suggested that they be authorized to make a thorough
inspection and study of all food supplies and mess conditions and report to
General Pershing, through the chief surgeon, A. E. F., on the following subjects:^
The quality of all Army subsistence supplies; the adequacy of the field ration
(permissible and desirable modifications of the ration from the standpoint of
transportation difficulties) ; balancing of menus (the desirability from the stand-
point of economy of simultaneous menus for entire divisions) ; improvement in
mess conditions with a view to the greatest conservation of food consistent
with adequate feeding; suitability of hospital dietaries; suitability of rations
used in prison camps with a view to greater economy; correlation of practical
experience of other armies with regard to rations and mess conditions and its
application to our own forces.
This letter was accompanied by documents which described the work
already performed by the food and nutrition service in Army camps in the
United States.'^
Among the members of this initial group and the personnel who reinforced
it later were men who in civil life had been State food commissioners, experts in
the Bureau of Chemistry, physiologists, biochemists, organic and analytical
chemists, State and city food inspectors, and those who had had practical ex-
perience in the large packing houses in the United States.^ Members of the
section throughout were selected because of their knowledge of its specialties,
with the result that collectively they were qualified to solve the scientific and
practical questions pertaining to its activities.* The officers composing the
first group sent overseas had received training from three to six months in
the camps in the United States, and the others who came later received train-
ing during variable periods.* Having been trained in the United States,
where saving privileges on the garrison ration were permitted, members of
this section were not as familiar as could have been desired with preparation
of the garrison ration if it were not supplemented b}^ purchases nor with the
possibilities of the rolling kitchen — i. e., with basic conditions pertaining to
the preparation of food in the American Expeditionary Forces.*
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 215
The officers composing the initial group remained in England from March
16, to April 2, 1918, studying the British system of rationing and its admin-
istration and making a preliminary survey of the service of food in American
rest camps/ One officer who was detached to remain in England and to
attempt correction of the nutritional defects there discovered in the American
service remained on this duty until the end of November, 1918/ The other
members of the group proceeded to France, where they reported to the chief
surgeon, A. E. F., April 12. The chief of this service was assigned to duty
under the director of the division of laboratories and infectious diseases,
with office at Dijon, and the other members to different sections of the Serv-
ices of Supply, in order that they might conduct inspections therein concern-
ing food and nutrition, make practical recommendation, and improve the
subsistence of troops/ When these assignments were made the chief surgeons
of the sections concerned were notified of the nature of the work the officers
would perform, and their cooperation was requested.^ After these inspections
were completed the members of the group held a conference at Dijon, where
they discussed the defects they had noted in food suppl}^, its preparation
and service/
In order to promote the correction of these faults and to study nutritional
I'equirements that would eventuate if it became necessary to reduce the quan-
tity of the ration, the chief surgeon, A. E. F., directed that a food and nutrition
section be established under the control of the director of the division of labora-
tories and infectious diseases/ To this section the following duties were
assigned/ Kepresentation of the chief surgeon, A. E. F., in matters pertain-
ing to the nutrition of troops; investigation of Army food requirements and
consumption; advisory service in the specification of rations and dietaries;
inspection of food supplies and mess conditions with troops, hospitals, and
prison camps; instruction in food inspection and handling, mess management,
and other measures for the maintenance of nutrition and for the conservation
of food/ The organization of this section was announced in Circular No.
37, chief surgeon's office, in June, 1918, and in the following month its duties
as noted above were published in Circular No. 40, chief surgeon's office, July
20, 1918. It acted on all matters of importance pertaining to the food supply
of the American Expeditionary Forces, maintaining close liaison with the
chief quartermaster, A. E. F., and with the fifth section of the general staff,
A. E. F., which w^as charged with instruction and training.^
Based upon a survey which four officers of this service made in May and
June, 1918, of the food conditions in six divisions in the advance section, finding
it advisable that personnel qualified to give instruction be attached to these
organizations for more or less permanent duty, moving with them in successive
changes of station, the representative of the Medical Department with the
fifth section of the general staft", on July 8, 1918, submitted the following memo-
randum to the acting chief of staff G-5 :
Subject: Project for Instruction in Cooking and Food Conservation.
1. Cooking schools. — Instruction in food values, selection and balancing of the ration,
mess management, cooking, use of the rolling kitchen and improvised cooking devices, arrange-
ment, cleaning, and care of kitchenequipment,storage, preservation, and conservation of foods,
216
AD^riXISTHATIOX, A^rKHI(■A^' EXPKDIIIONAKV FORCKS
and kitchen sanitation is given to selected replacements in tlic school for Army cooks in con-
nection with the scliool for bakers at the base division, first cori)s. Similar schools are i)ro-
jected in other base divisions.
2. Field parties. — Officers of the food and nutrition section of the Medical Department
have been visiting the various divisions and base sections in France for jiurposes of obser\ a-
tion and instruction, and three are now on duty with the United States troops in England.
Action has been taken to secure additional trained officers of the food and nutrition section
from the United States in order to give sufficient personnel for extension of the work. Field
parties (consisting of one officer of the food and nutrition section, one butcher, and two cooks)
will be assigned to a certain area corresponding to that covered by the division of any army
corps and will be kept moving from division to division within that area. They will obs(>r\c
the methods of distribution and handling of the ration, mess management, cooking, kitcluMi
economy, serving and food conservation, and will establish temporar\^ centers of instruction
for mess sergeants and the methods and procedures adapted to the conditions found.
3. Source, control, and distribution. — Officers engaged in this work will come from the
officers of the Sanitary Corps, food and nutrition section of the Medical Department. Tiic
butchers will be secured from the enlisted men of the Medical Department, Quartermaster
Corps, and from replacements trained in the cooking schools. Control of field parties and per-
sonnel attached to base sections and various headquarters will lie in the sanitary section of the
office of the chief surgeon in cooperation with G-5. Control of the instructors of the various
schools will lie with the commandants of these schools, or the commanding officers of the base
divisions in cooperation with G-5. Distribution will be tentatively as follows:
At Medical Department laboratory: officers
Officer in charge food and nutrition section (general supervision) 1
Officer on duty in the food laboratory 2
Officers for emergency examination and instruction 2
On duty at base section in England 3
On duty at base sections in France 5
On duty at First Corps schools 2
On duty with hospitalization section, chief surgeon's office 1
On duty with chief quartermaster 1
On duty at cooking schools 2
19
Butchers
Cooks
10
4
Officers
Field parties:
For 5 army corps _
Services of Supply troops
2
.5
2
7
14
<• 26
« Including 19 from above.
Increases in personnel and parties will have to be made as necessity arises.
With the approval of the assistant chief of staff G-o and the cooperation
of the chief quartermaster, the section now organized field parties, each of which
consisted of one officer from the food and nutrition section, one butcher, and
two cooks, with the grade of noncommissioned officer, the last mentioned being
drawn from the Medical Department, Quartermaster Department, and replace-
ments.^ During the period of its greatest activity about 40 noncommissioned
officers, cooks, and butchers were assigned to the nutrition service, most of
them being incorporated into the field parties. These units were sent to divi-
sions at the front training areas, military schools, and later to organizations in
sections of the Services of Supply." Before a party reported to the organization
OBGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 217
to which it was temporarily assigned, the adjutant general, A. E. F., sent to
tlie commanding officer concerned the following form letter:
1. In compliance with instructions from these headquarters a field party of the food and
nutrition section, Medical Department, has been assigned for temporary duty with the
organizations of your command.
2. This field jiarty is charged with the investigation of ration conditions as to trans-
I)ortation, handling, preparation, and conservation, and instruction of mess sergeants and
cooks as to field mess management, field cooking, and conservation within these organizations.
3. It is desired that the officer in charge of the field party be given proper authority
und support in order that he may carry out the duty to which assigned. The officers in
charge of the field party have been directed to make reports to the director of the Medical
Department central laboratory, A. E. F., and authorized to make reports to the division
surgeon of the organization with which he is on duty, or as you may direct. Attached find
a copy of "Duties of field food and nutrition officers," which will fully explain the duty
required of this party.
Duties of Field Food and Nutrition Officer-s
procedure on reporting to the organiz.\tion
1. Report through adjutant to the commanding officer. Present to him your orders,
with a statement of your duties, and request that local orders or authority be issued. Sug-
gest that the local order authorize you to inspect all food materials from their receipt by the
organization to their consumption by the men; to inspect condition of all kitchens and the
efficiency of their administration; to give instruction to mess sergeants and cooks in mess
administration and in the storage and preparation of food, and to make recommendations
to organization commanders, mess officers, and to the commanding officer in matters affecting
the proper feeding of the men and the conservation of food.
2. Report to the division surgeon or senior medical officer, explain your mission, present
to him your instructions, request his advice, and follow his suggestions.
3. Consult witli the railhead officer, division quartermaster, or subsistence officer and
supply officers and examine food supplies to obtain information re the ration issued, the
various components, their percentages, quality, period of issue, storage facilities, and method
of distribution.
4. Visit all kitchens in the organization; note and record in each the points covered in
the outline of the reports. Give individual instruction personally, and through noncom-
missioned officers of the field party, to mess sergeants and cooks for the improvement of the
mess and avoidance of waste. See that they know what the ration is and whether they get
all of it. Consult organization commanding officers and make recommendations to them
where desirable.
5. Choose one or more centrally located kitchens illustrating conditions in the area and
develop them as models for the practical instruction in cooking, mess administration, and
avoidance of food waste. Build here model l>read boxes, shelves, meat safes, work tables,
grease traps, and any other devices which can be made of the materials at hand or obtainable.
Assemble here, with the permission of the proper authorities, the officers, mess sergeants,
cooks, and men of different units and demonstrate the advantages of your devices, the impor-
tance of good meals, and the necessity of avoiding waste. Accept and stimulate suggestion
and criticism. Devi.se a system of competition between messes, involving the recognition
and public mention of excellence.
6. If accompanied by the noncommissioned officers, cooks, mess sergeants, or butchers,
distribute them at various points in the area so as to give the necessary practical distribution
over the whole organization as quickly as possible.
7. Your first duty is to improve the food as served to the men. Fooc^ conservation is
merely giving the men more and better food and putting less in the garbage pail and extracting
or saving for mess consumption or commercial use all material of value. In training areas
and in positions not exposed to shell fire there should be no food waste; material not used
should be deducted from the following issue, with corresponding reduction in transportation,
tonnage, and drain upon resources at home.
218
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
With troops occupying trenches or positions under shell fire there will be frequent
and inevitable waste of food as well as of other material. Your duty under such conditions
is to urge that such food be allowed and delivered as will make possible the proper feeding of
the men in spite of unavoidable waste. Study the food needs of the men and take steps to
insure that the needs are complied with.
Report on anj' unusual requirements of particular troops.
8. Make reports weekly to the food and nutrition section, A. P. O. 721.
9. Notify the food and nutrition section one week in adv^ance of the time that your
work within a division is to be completed, requesting orders to move to another organization.
REPORTS
1. Officers will make oral or written reports to commanding officers through division
surgeons or other officers under whose direction they work. These reports should contain
a brief statement of conditions found and specific recommendations for their improvement.
Avoid long reports. Don't criticise unless you are able to have the fault corrected. Be
sure that your recommendations are practicable — otherwise don't make them. Correct
faults by informal conference and suggestion or by your own efforts before writing reports
about them. Always pay due respect to military courtes}- and the limitations of your
authority, which is only advisory.
2. In addition to reports within the organization, officers will make regular reports
weekly by mail to the director of laboratories, food and nutrition section, A. P. O. 721, and
special reports by telegraph whenever necessary. Officers in the various sections of the
Services of Supply will similarly report to the chief surgeon in that section.
3. The outline below will serve as a guide in inspections and in the preparation of
weekly reports. Adhere to the numbers as stated and it will permit considerable aljbrevia-
tion. In reports after the first, from each division it will usually not be necessary to repeat
items under A. B., etc., covered in the first report.
To: Director of laboratories, food and nutrition section.
Heading: Organization; date covered by report.
Party No.: Number of report-
Contents:
A. Information obtained at the railhead or chief supply point.
1. Storage facilities.
2. Amount of reserve food on hand, (1) garrison ration, (2) field ration, (3) reserve
ration (4) trench reserve ration, (5) travel ration.
3. Wastage at railhead or in reserve storage.
4. Ration being issued with proportion of each component and substitute.
5. Period of issue; system of issue.
6. Quality of food material.
7. Desirable ration changes.
8. Arrangements for food salvage.
9. Faults requiring correction.
10. General comments.
B. Transportation of food.
C. Conditions at regimental food dumps or similar food supply points (Nos. 1 to 10,
as under A).
D. Report on mess inspections.
(1) Name of organizations; (2) commanding officer; (3) mess officer; (4) mess ser-
geant with his knowledge of ration efficiency; (5) number of men fed; (6) number of cooks
and efficiency; (7) general appearance of kitchen (good, fair, poor, excellent); (8) stove
facilities roller kitchens, fuel; (9) cooking utensils; (10) storage facilities; (11) sanitation —
kitchen surroundings, personnel; (12) w^aste, garbage, amount, character, disposal, reasons;
(13) menus — character; (14) water supply; (15) arrangements for washing mess kits and
dishes; (16) character of service — mess hall, tables, line system, billets, dugouts, trenches,
marmites; (17) is food good and are men satisfied; (18) shortage or overdraft shown on
ration slips; (19) conditions requiring correction and your action; (20) where pos.«ible
ORGAXIZATIOX AND ADMINISTEATION OF CHIEF SURGEON'S OFFICE 219
calculate or estimate the gross and net food consumption. Record any significant facts
not covered above, such as weather conditions, activity of the men, etc., which affect the
food consumption; remarks; (21) estimate the amount of food purchased by individual
men from data obtained from the canteens, from inquiry from the men or from stores in the
vicinity; (22) estimate the amount of food purchased by the organization to supplement
the ration; its source; (23) estimate of wine consumption.
E. Give in detail such methods of instruction and demonstration as you have used,
with comment on their success.
A field party under the immediate direction of the division surgeon and the
sanitary inspector of the organization to which it was assigned (or corresponding
officers in other commands) inspected the food supply from its receipt at railhead
to its consumption; investigated mess management and mess sanitation;
studied the methods of issuing and distributing rations, food preparation, and
service, and, by informal conference with those concerned and by practical
demonstration, corrected as far as possible any faults in supply, preparation, or
conservation of food.^ The parties were given a degree of independence which
enabled them to develop their own resourcefulness and to adapt their activities
to the conditions which the immediate occasion demanded. ^ These parties
worked in close conjunction with divisional agencies, especially the first section
of its general staff, the sanitary inspector, the inspector general, the quarter-
master, and the several organization commanders. They made detailed
inspections of kitchens and instructed personnel, either individually or in groups,
gave demonstrations and lectures, and distributed circulars. From January
to June, 1919, they gave most of their time to schools which they conducted
for mess sergeants and cooks. The program which these parties sought to
follow was one which they believed would insure, under mutable conditions, that
food was regularly provided and handled to the best advantage in so far as
storage, preparation of menus, cooking, serving, sanitation, and economy were
concerned.'*^
The field parties did not follow inspections by elaborate reports, for they
were primarily engaged in constructive criticism and instruction at each mess
inspected, but such reports as were necessary and required were made to organ-
ization commanders and to supply officers.^ Weekly reports were sent by these
parties to the food and nutrition section in Dijon in order that it might be kept
apprised concerning the suitability of the ration under changing conditions, the
quality of supplies, defects detected, progress being made, and other matters.^
These reports formed the basis for recommendations pertaining to the ration
which this section submitted. It wrote, for example, an order which was
adopted with but few changes by the chief quartermaster, A. E. F., and which
was published as General Orders, No. 176, General Headquarters, A.E.F., 1918.^
Until September, 1918, when 20 additional officers pertaining to this service
arrived from the United States, and two others were assigned thereto from other
duties, only the five officers of this section originally serving in France were
available there for the service of this section.'' One officer of the group first
sent, had remained as stated above, in base section 3 (England) ; two, at Dijon,
were engaged in development of the organization of the section, solution of
problems referred to its headquarters and in special investigations, while the
other three served with field parties which visited different divisions.^ As but
220
Al>.MlXISTRATIOX, AMKHR'AX KXrKDITlOXAHY FOHCES
few organizations could be given attention for any considerable period a read-
justment and concentration of effort became necessary in the armies, and a plan
was adopted which contemplated that the field parties be sent to headquarteis
of different corps in order that they might serve their constituent divisions, but
until troops returned to billeting areas after the signing of armistice, the shift-
ing of troops was so frequent that this method proved unsatisfactory. There-
after it was the reverse.^
After the group of 20 officers above mentioned had joined the section,
September 1, 1918, others gradually were added, until 43 were on duty with it
when the armistice was signed. ' Of this total, four officers belonged to the
Medical Corps and all others to the Sanitary Corps. ' Seventy-three enlisted
men, most of whom were serving in the field parties, also were serving in this
section at that time. By December, 1918, parties had been attached to IS
divisions for periods varying from a few weeks to several months; and w^ith five
of these, two or more parties had been on duty at different times. After
January 1, 1919, field parties assigned to army corps served six other divisions
and eventually they had served 8 corps and 26 divisions.'
After October 18, 1918, when the director of laboratories and infectious
diseases was authorized to issue travel orders for the movement of these groups
their mobility and value in meeting emergencies was greatly increased.^ Such
orders were issued for specific purposes only; e. g., investigation of epidemics of
food poisoning, inspection and prompt recommendation concerning the preser-
vation of food, and similar purposes.'
After the strength of the food and nutrition service was increased in Sep-
tember, 1918, additional field parties were organized, and soon thereafter it
became possible to provide officers for base sections Nos. 1, 2, 5, and 7 (in addi-
tion to base section No. 3, provided for at the outset) and for the intermediate
section. ^ Officers or parties also were stationed at 10 large camps for consider-
able periods, and repeated inspections w^ere made of supply, preparation, service
and conservation of food as well as other matters pertaining to the mess service
at practically all camps in base sections. Many other inspections which sought
to be of constructive value w^ere made of other organizations including hospitals
in the base and intermediate sections. In base section No. 3 where four officers
were on duty for more than five months, practically all organizations were
inspected, many of them repeatedly. ^
The most important problems which confronted the section of food and
nutrition during the winter of 1918-19 were the following:' (a) Inspection and
report upon needs of labor organizations requesting increases in the ration in
accordance with General Orders No. 176; (6) continuation of the inspection
and instruction w^ork in base sections with added emphasis on the messing
conditions in the embarkation camps; (c) continuance of instruction to divi-
sional troops in the first, second, and third Armies and the development of
instruction concerning cooking in their component units; (d) the appointment
of special inspectors to safeguard the nutritional interests of our troops on return-
ing commercial liners; and (e) assistance in solving the food problems of the
section of civil government in the occupied territory in Germany.' The food
and nutrition section also provided a representative for investigation and advice
OKGAXIZATIOX AND ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 221
(oncoiiiino; matters pertaining to his specialty in the Third Army and another
who supervised messing conditions in the district of Paris, and investigated
questions of factory sanitation that were of interest to the Quartermaster
Corps/
From November to May the following new features developed in the
woik of the section:^ The supervision and assistance in the organization of the
large embarkation messes at the base port. This covered base sections Nos.
1, 2, 5, 6, and the embarkation center at Le Mans. At these same base ports
a member of this section in each base served officially on the boards which
inspected transports to determine the proper food equipment of the same.
At advanced general headquarters one of our officers served as food and nutri-
tion consultant on the staf? of the officer in charge of civil affairs and there
rendered valuable service in determining the food supply of the occupied
territory.
From January to June, 1919, the officers assigned to army corps (where
they were attached either to the corps surgeon's office, to G-1 or G-3 of the
corps) exercised general supervision over the nutritional service of divisions and
devoted much of their time to the development of schools for mess sergeants
and cooks. ^
Of the numerous investigations ° which this section conducted the following
were practically noteworthy, viz, food conditions in the zone of the armies, on
the Murman coast, and in the sections of the Services of Supply; food service in
hospitals; caloric value of the ration; laboratory examinations and analyses of
food; inspection of factory conditions pertaining to food supplies; special prob-
lems regarding bread and meat issues; rations for later troops and food supply
and its service on transports, especially on commercial liners hired for transport
purposes by the United States.^
The services of the food and nutrition section for the American Expedi-
tionary Forces as a w^hole was terminated May 26, 1919, but was continued so
long as circumstances required in the administrative sections of the Services
of Supply and in the remaining army corps, the work being so arrainged that
officers employed therein could automatically be released when their services
W(M'e no longer necessary.'
MUSEUM AND ART SECTION
For the purpose of collecting suitable medical museum specimens, the
Surgeon General, in January, 1918, requested authorization from the command-
ing general, A. E. F., to send to France a medical museum unit with a desig-
nated director.'^ After receipt of the authorization, and a period of two
months spent in planning for the collection of museum material in the camps
and cantonments of the United States, the director of this unit was ordered
fo England in order that he might study both the collections made and methods
of collecting employed by the British Army, and was then sent to France for
further duty.'- In the meantime Circular No. 17 had been issued by the
chief surgeon, A. E! F., calling attention to the importance of collecting museum
specimens and giving brief directions for their preservation.'^
° For (letnils concerning Ihese investigations, consult Chap. VI, Sec. II, Volume VI, of this history.
222
ADMIXISTRATIOX, AMERICAX EXPEDITIONARY FORCES
The collection of museum and ait material in France was made a respon-
sibility of the division of laboratories, for it early became apparent that the
procurement of pathologic material would be wholly dependent on the effi-
ciency and activity of the officers who performed autopsies.'^ The first task,
therefore, w as the improvement of the necropsy service in the American Expedi-
tionary Forces, which at that time, because of lack of personnel for such
service, was very inadequate. During the summer of 1918 it became evident
that there existed a great need for a routine service of this character which
would afford a means of professional inspection of the measures which medical
officers employed in their care of patients.'^ This inspectorial need was filled
in satisfactorily, and, although the number of pathologists was constantly so
limited that they could not give more than incidental attention to the col-
lection and preservation of pathologic material, their collections were more
extensive than could have been hoped for under the circumstances.^^
Since General Orders, No. 15, H., A. E. F., January 24, 1918, limited
the practice of photography in the American Expeditionary Forces, in so far
as obtaining a pictorial history of the war was concerned, to the Signal Corps,
the chief surgeon, A. E. F., in March, 1918, approved an elaborate schedule
for the taking of photographs by that corps for the purpose of illustrating
the medical history of the war.^^ In order that other technical photographs
might be procured, a request w^as made early in May for the privilege of cabling
for photographers and artists who were then in readiness to proceed from the
Army Medical Museum in Washington, but this was disapproved by the
general staff, A. E. F., in view of the existing tonnage situation, and in the
belief that the requirements of the Medical Corps could be met successfully
in this particular by the personnel and facilities already available, in both the
Signal and Engineer Corps.
On May 3, 1918, the director of laboratories notified the chief surgeon
that provision was contemplated for photographic work on anatomical mate-
rial in the advance section and in the central Medical Department and base
laboratories.^^ It w^as believed that a sufficient number of men for this pur-
pose could be found in the American Expeditionary Forces, and it was planned
to train them, at the central laboratory, in the simple laboratory procedures
so that they could serve both as laboratory assistants and as photographers.'^
Another acquisition desired by the museum and art service of the division
of laboratories was a number of artists who could make sketches of anatomi-
cal specimens and of medical and surgical procedures.'^
In July, the division of laboratories reported to the chief surgeon, A. E. F.,
the lack of men in the Signal and Engineer Corps who had special training in
preparing medical illustrations and urged the necessity for special training
along such lines in order that good results might be procured.'^ As a result,
a cabled request was made to the War Department that a museum unit, con-
sisting of a cinematographer, a photographer, and four artists, with complete
equipment and supplies for six months, be sent to France. One officer and
seven enlisted men, equipped for making moving pictures,' arrived in France
September 14, 1918, pursuant to this cablegram.'^
General Orders, No. 78, G. H. Q., A. E. F., May 25, 1918, amended pre-
vious orders on the use of cameras in the American Expeditionary Forces, and
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 223
charged the Medical Department with making technical photographs of sur-
gical and pathological interest. To carry out this responsibility, the officer in
charge of the museum and art section made a survey of the Medical Department
personnel and pertinent equipment in the American Expeditionary Forces.
Several men were found who had been trained in photographing medical sub-
jects, but because of the order previously issued concerning the taking of
photographs, almost no hospitals were found equipped with photographic
apparatus.'^ Those that were so equipped were authorized to place their
equipment in use.'^ A few cameras were procured from French sources, 3 were
borrowed from the Signal Corps, and 24 from the Roentgenologic department
of the professional services.'^ A limited amount of photographic supplies was
obtained from French sources.'^
An examination of the feasible sources of supply — American, French, and
British — revealed the fact that nothing but formalin was obtainable for the
fixation of pathologic specimens, except in a few base hospitals which had first
arrived in France and which had brought with them a small supply of alcohol.'^
The only materials available for color preservation were sodium or potassium
acetate and nitrate, one or the other of which was obtained after long delay
from the French. These materials, photographic and pathologic, were placed
in the central medical supply depot, but the facilities there for distribution
either of these or of the other Medical Department supplies used in the museum
and art service were inadequate.'^
After a careful survey of the situation, Circular No. 42 was issued by the
chief surgeon's office.'^ This 'circular, which gave technical instruction con-
cerning the collection and preservation of specimens, is reproduced in the
appendix to this volume.
As a result of these efforts, the increase in the total number of pathologists,
their assignment at advantageous points, and personal appeals while inspecting
laboratories, much interest in the collection of museum material was developed.'^
But the battle activities in June and July so overwhelmed the laboratory divi-
sion that very few pathologic specimens were collected at that time.'^
On September 15, 1918, the director of laboratories wrote, through the
chief surgeon, to the chief quartermaster under whom the officer in charge of
salvage was operating, stating that it was important that certain articles
of interest to it, which were employed in allied armies or in that of the enemy,
be collected and transferred to the Medical Department.'^ These articles
included drugs, sera, chemicals, apparatus, instruments, etc., and ordnance.
He stated that the Army Medical Museum was charged with the collection of
such material and the provision of arrangements whereby it would be made
available for future studies and requested that such articles of the character
mentioned as had been selected by a medical officer be transferred to the divi-
sion of laboratories for shipment to the Army Medical Museum in Washington.'^
In October and November the epidemic of influenza, coinciding as it did
with the Meuse-Argonne operation, the period of greatest battle activity in
the American Expeditionary Forces, again overwhelmed the pathologists,
though by this time their number had materially increased.'^ By this time,
13901—27 15
224
ADMINISTEATIOX, AMERICAN EXPEDITIONARY FORCES
also, an excellent necropsy service had been developed, but only relatively
slight attention could be given to the collection of specimens.'^ Nevertheless,
despite the limited personnel and the lack of equipment, of supplies, of con-
tainers, of transportation, of time, and in fact of everything except a multitude
of specimens, upward of 6,000 pathologic specimens were collected, preserved,
and shipped to the Army Medical Museum.'^ Most of these related chiefly
to war wounds and to gas poisoning.'^
Early lesions of war gas poisoning were especially difficult to obtain, owing
to lack of transportation facilities and of pathologists, and to the necessity for
the collection of specimens for immediate study at the pathologic laboratory
in the Chemical Warfare Service, with which the Medical Department attempted
to cooperate in every possible manner. However, a small but a fairly repre-
sentative collection of these lesions was assembled. By December 26, 1918,
most of the pathologic specimens from gas-poisoning cases had been forwarded
to the laboratory of the Chemical Warfare Service for study, and the others,
which had been held at the central laboratory, had been shipped to the Army
Medical Museum.'^ A number of good specimens illustrating the more striking
types of lung lesions occurring during the epidemic of influenza in the fall of
1918 were preserved.'^ Lesions illustrating the often unique course of typhoid
and paratyphoid fever in men who had received specific prophylaxis also were
collected in considerable numbers during the fall and winter of 1918-19. Fairly
good collections were made of specimens illustrating lesions of the brain, and of
peripheral nerves and certain other conditions.'^
About 2,000 microscopic slides of tissue were collected and shipped to the
United States.'^
A small collection of missiles which had caused injuries and which had been
removed at surgical operations was preserved, but most of these were returned
to W'Ounded soldiers, pursuant to Circular No. 42, Chief Surgeon's office. A
fairly complete collection of unused small-arms missiles and fixed ammunition of
the several belligerent nations, a few specimens of heavy ordnance missiles and
of their fragments, and a representative collection of rifles, pistols, bayonets,
trench knives, and other weapons were forwarded to the Army Medical Museum.'^
On January 13, 1919, the commander in chief instructed army commanders
and the chiefs of all technical and supply divisions concerning the collection of
material for historical and exhibition purposes.'^
A large collection of helmets, which showed evidence that they had either
warded off missiles or been penetrated by them, a small number of pieces of
body armor, and other metal objects such as canteens, mess kits, trench mirrors
etc., which also showed they had been struck by missiles, were collected and
shipped to the museum.^ A number of surgical instruments and other items
in Medical Department armamentarium, which had been developed or materi-
ally modified in our service, or in those of our allies, or in that of the enemy dur-
ing the progress of the war were collected and shipped.'^
In September, 1918, several artists (medical illustrators, w^ax modelers,
and others) had arrived in France attached to Base Hospital No. 115, which was
stationed at Vichy. An art and photographic section was therefore established
in Vichy in the center laboratory of the hospital center, using this personnel
ORGANIZATION AND ADMINISTEATION OF CHIEF SURGEON'S OFFICE 225
and its equipment.'^ Other artists were assigned from to time to time to this
art section and were ordered out therefrom to various hospitals in the American
Expeditionary Forces where opportunities afforded making illustrations of medi-
cal or surgical subjects. This group produced 35 casts of surgical cases, about
200 drawings and paintings, and more than 1,000 photographs of technical
subjects.'^ In addition to these illustrations and photographs, which were
centered at Vichy, a number of other drawings, paintings, and photographs of
technical subjects were made in other hospital centers, particularly at Allerey,
Beaune, Chateauroux, and Paris.
The cinematographer, photographers, and artists cabled for in August, 1918,
reported for duty to the director of laboratories in the following month.
This personnel was distributed as advantageously as possible, principally to
cover the activities of combat divisions. Here they remained on duty until the
signing of the armistice. Late in September, 1918, the museum section of the
division of laboratories had been charged with the duty of cooperating with the
Signal Corps in making photographs for the medical and surgical history of the
war.'^ The Signal Corps, though it had been authorized in March, 1918, to
prepare such photographs, had been able to cover but little of the medical
activities of the American Expeditionary Forces except the more popular sub-
jects which were needed for propaganda purposes. After the signing of the
armistice and as soon as the general photographers of the Medical Department
could be released from their duties with combat divisions, a photographic
bureau of the Medical Department was established in Paris for making and
collecting photographs and moving pictures Olustrative of the medical activities
in the war.'^ Personnel of both the Medical Department and of the Signal
Corps were assigned to this duty.^^
The negatives of the medical pictures taken by the Signal Corps photog-
raphers were developed by them and two prints of each made for the Medical
Department bureau, the negatives being retained by the Signal Corps. The
negatives made by medical personnel were developed, printed, and filed in the
Medical Department bureau. This bureau filed more than 10,000 still pictures,
titled and cross indexed, supplied about 5,000 proof copies to hospital organi-
zations for use in their several histories, and furnished 1,500 prints for medical
officers of the general staff of general headquarters.^^ The bureau also photo-
graphed about 350 dental specimens. It made about 40,000 feet of moving-
picture film of surgical and medical subjects, such as activities in and around
hospitals, rehabilitation of convalescent patients, care of psychiatric cases,
etc., and filed about 20,000 feet of other motion pictures made by Signal Corps
photographers. Nineteen copies of the motion picture, "Fit to fight," were
made for circulation in the American Expeditionary Forces. Two other
propaganda pictures — "Fit for America" and "How to avoid typhoid fever" —
and six copies of a two-reel anatomic picture concerning venereal diseases were
also made.'^
The Roentgenologic division of the professional services, on request from
the division of laboratories, packed and shipped about 2,000 selected X-ray
plates from their point of origin directly to the Army Medical Museum. These
were selected for their technical quality as well as for their scientific interest and
226
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCEf^
covered in a number of instances special series of cases or series which showed
different stages in the treatment and healing of the same case.'^
Immediately on the signing of the armistice it became obvious that trans-
portation facilities for specimens, not only within the American Expeditionary
Forces but also from base ports to the United States, would be exceedingly
limited. A supplemental museum circular (No. 58) was therefore issued
from the chief surgeon's office December 2, giving directions for expediting
transportation and calling attention to the desirability of obtaining material
showing stages of healing, etc.^^ As a result of this circular the transportation
of pathologic specimens directly to base ports from their points of origin instead
of through collection centers was materially expedited, as this proceedure
required that dependence be placed on a large number of shippers for report
of details concerning the individual specimens they forwarded, there even-
tuated in some instances a lack of the detailed information desired.'^ The
shipment of museum material to the United States was greatly hampered by
the inevitable confusion incident to general shipping conditions in France and
to the lack of tonnage at the close of the war. All the specimens, however,
were carefully packed, and it was believed they would not materially deteri-
orate even if delayed one or two years in transit.
LABORATORY OF SURGICAL RESEARCH
In order that use might be made of the unusual opportunities which the
World War afforded for the study of certain conditions, such as shock and
hemorrhage, which occur both in military and civil practice, and in order to
obtain information wherewith to meet new experiences in war surgery, as
these arose, a laboratory for surgical research was established at Dijon.
This organization was established on the initiative of the chief surgical con-
sultant and connected with the central Medical Department laboratory. Plans
for carrying on the research work were perfected in January, 1918, but it was
not until May 1 of that year that active work was begun. Two divisions
of the unit were established, physiological and surgical, the former being
staffed by 4 officers and 3 enlisted men and the latter by 6 officers, 2 nurses,
and 2 enlisted men. Investigations of problems connected with shock and
hemorrhage and the development of a satisfactory technique in the treatment
of chest wounds were the first studies undertaken.^'' Studies concerning
shock and hemorrhage progressed in such a favorable manner that late in May
instruction was begun of classes in resuscitation, and thereafter teaching and
investigation were closely associated in this service. With a few interrup-
tions, classes of from 6 to 21 officers were instructed each week until November
1, 1918, the successive courses of lectures and demonstrations being gradually
amplified and improved. Members of the classes draw^n from the surgical
staffs of base hospitals, were organized in resuscitation teams, and when needed
they were to be ordered to hospitals at or near the front. This plan was not
altogether satisfactory. In many cases the personnel in question could not be
released from their units for this purpose and as a result some of the resusci-
tation teams in forward hospitals had not received the instruction referred to.^'
The teaching staff of the surgical research laboratory also gave instruction
monthly to the classes in the sanitary school at Langres.'"
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 227
Meanwhile surgical research was prosecuted, some studies of this char-
acter being conducted in British hospitals. Research in the treatment of
chest wounds was conducted by a team of 6 officers, 2 nurses, and 2 enlisted
men.'^ These studies were not completed but certain principles apparently
were established and surgical operations simplified accordingly.^^ A project
to establish an advance surgical research laboratorj'^ where observations could
be made on recently wounded men was contemplated but never materialized.^^
REFERENCES
(1) Report of the activities of the water analysis laboratories, to January, 1919, by Lieut.
Col. Edward Bartow, S. C. On file. Historical Division, S. G. O.
(2) Report of water analysis work at the central Medical Department laboratory, Dijon,
France, January 25, 1919, by Captain H. B. Hommon, S. C. On file. Historical
Division, S. G. O.
(3) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file,
Historical Division, S. G. O.
(4) Letter from the chief surgeon, A. E. F., to the Surgeon General, January 18, 1918.
Subject: Recommendation for food division. On file, A. G. O., World War Division,
chief surgeon's files (720.1).
(5) Cablegram No. 614, par. A, from General Pershing to The Adjutant General, February
18, 1918.
(6) Memorandum from the Surgeon General to the chief surgeon, A. E. F., March 1, 1918.
Subject: Officers reporting for duty. On file, A. G. O., World War Division, chief
surgeon's files (720.1).
v7) Letter from Maj. P. A. Shaffer, San. Corps, December 6, 1918, to the director of labora-
tories, A. E. F. Subject: General report from the food and nutrition section, from
its establishment to December 1, 1918. On file, Historical Division, S. G. O.
(8) Report on the section of food and nutrition, personnel, August 8, 1919, by Maj. Walter
H. Eddy, S. C. On file, Historical Division, S. G. O.
(9) Letter from the chief surgeon, A. E. F., to chief surgeons of sections concerned, April 12,
1918. Subject: Duties and cooperation of food and nutritional officers. On file,
A. G. O., World War Division, chief surgeon's files (720.1).
(10) Report on the section of food and nutrition, food problems with combat troops in France,
August 8, 1919, by Capt. C. C. Mason, S. C, and Lieut. A. T. Shohl, M. C. On file,
Historical Division, S. G. O.
(11) Letter from the adjutant general, A. E. F., to commanding officer of the organization
concerned, September 20, 1918. Subject: Assignment of field party, food and nutri-
tion section. Copj' on file. Historical Division, S. G. O.
(12) Report on the museum and art service of the American Expeditionary Forces (undated),
by Col. Louis B. Wilson, M. C. On file, Historical Division, S. G. O.
(13) Letter from Lieut. Col. J. F. Siler, M. C, director of laboratories, A. E. F., to the chief
surgeon, A. E. F., May 3, 1918. Subject: Photographic work in laboratory service.
On file, A. G. O., World War Division, chief surgeon's files (321.630).
(14) Letter from Lieut. Col. J. F. Siler, M. C, director of laboratories, A. E. F., to the chief
quartermaster, A. E. F., September 15, 1918. Subject: Transfer of certain material
to the Medical Department. On file, A. G. O., World War Division, chief surgeon's
files (700.6).
(15) Fourth indorsement from director of laboratories, A. E. F., to the Surgeon General,
U. S. Army, December 26, 1918, on letter from Major M. C. Winternitz, M. C, to
director of Chemical Warfare Service, November 7, 1918. Subject: Study of human
pathology of poison war gases. On file. World War Division, chief surgeon's files
(321.630).
228
ADMINISTRATION, AJklEKICAN EXPEDITIONARY FORCES
(16) Letter from commander in chief, A. E. F., to army commanders and all technical and
supply divisions, January 13, 1919. SuV)ject: Collections of materials of historic
value. Copy on file, Historical Division, S. G. O.
(17) Report on the services of the laboratory of surgical research, American Expeditionary
Forces, at Dijon, December 7, 1918, by Lieut. Col. W. B. Cannon, M. C, and Lieut.
Col. J. L. Yates, M. C. On file. Historical Division, S. G. O.
CHAPTER XIV
THE DIVISION OF HOSPITALIZATION
GENERAL OUTLINE OF DEVELOPMENT AND ACTIVITIES
The broader activities of the hospitalization division, especially in so far
as they pertained to projects, procurement, and organization of hospitals,
general control of the professional services. Medical Department transportation,
and evacuation of patients, are described in other chapters of this volume.
This chapter has to do only with a general outline of this division's develop-
ment and activities.
Securing adequate hospital beds was one of the earliest tasks, and con-
tinued to be one of the greatest and most difficult of the Medical Department
of the American Expeditionary Forces until after the armistice had been signed.^
That the needs as to hospital beds were met, generally speaking, and that there
was always a surplus of several thousand hospital beds, were the results of
great effort and the use of all possible expendients to utilize available resources
to the utmost.^
The necessity for close cooperation between the Medical Department of
the American Expeditionary Forces and the medical services of our Allies, espe-
cially France, in the provision of hospital facilities was apparent from the outset.'
Prior to the arrival of headquarters, A. E. F., the question of hospitals had been
taken up with the French Minister of War, and a Medical Department mem-
ber of the American mission with a medical officer of the French Army had made
an extensive inspection trip with a view of determining what French military
hospitals might be available and suitable for the American Expeditionary
Forces.' All Atlantic ports in France were visited and their hospital facilities
investigated,' so that even before the arrival of our first contingent of troops it
was possible for the French to begin work for us on a camp hospital at St.
Nazaire, and for the existing French hospitals in the vicinity of that port to be
evacuated and prepared for transfer to the American Expeditionary Forces as
soon as American personnel became available.'
After the arrival in France of the chief surgeon, A. E. F., he and the Amer-
ican medical officer above referred to covered almost the same itinerary as that
followed in the inspection trip which the latter already had conducted, with a
view of locating hospitals and Medical Department supply depots and of pro-
curing immediate facilities for the medical service of the troops then expected.'
When organization of the chief surgeon's office was amplified, July 28, 1917,
the hospital division of that office was charged with all questions that concerned
the Medical Department pertaining to the location, procurement, construction,
and repair of hospitals, the care and evacuation of sick and wounded, the pro-
vision and control of hospital trains, ambulances and barges, and the training of
Medical Department personnel.^ The chief of this division was also designated
liaison officer between the American and French medical services. The great
229
230
AD.MIXISTKATIOX, AMKKICAN EXPEDITK ).\ A K V FORCES
majority of Medical Department questions which required negotiation during
the early formative period of the American Expeditionary Forces pertained to
the procurement of hospitals and the determination of general policies.^
When the chief surgeon for the line of communications was assigned,
July 18, 1917, he was charged with certain duties then carried out by the office
of the chief surgeon, A. E. F/ These were to include control of base hospitals,
medical supplies and personnel in the line of communications. However,
until headquarters, A. E. F., moved, September 1, 1917, from Paris to Chau-
mont, there was very close contact between the chief surgeons of the American
Expeditionary Forces and of the line of communications in matters pertaining
to hospitalization as well as other affairs.^ Thereafter, in so far as hospitals
were concerned, the office of the chief surgeon, A. E. F., while located at Chau-
mont, was more particularly concerned with procurement of facilities and gene-
ral policies concerning hospitals. Very important parts of this service per-
tained to the fixation of the bed capacity of base, camp and evacuation hospitals*
the determination of the duty personnel required to serve units of each class'
the provision of convalescent camps and depots, and the preparation of the
plans and specifications for hospital construction.^ On the other hand, the
office of the chief surgeon, line of communications, was concerned with estab-
lishment of fixed hospitals throughout the expanding territory of the lines of
communications, the provision for their supply and the control of their adminis-
tration. When headquarters and the supply and administrative services of
the American Expeditionary Forces were reorganized by General Orders,
No. 31, G. H. Q., A. E. F., February 16, 1918, the chief surgeon moved with
the chiefs of most other administrative staffs to Tours, where his office absorbed
that of the chief surgeon, line of communications.^ Two of the officers who
had been identified with the hospitalization division of the chief surgeon's
office, A. E. F., remained at Chaumont, one of them being detailed to serve
as representative of the chief surgeon with the general staff, the other with the
fourth section of that body (with which the representative of the chief surgeon,
at G. H. Q., soon identified himself). Another officer was now placed at the
head of the hospital division.^ This division was now charged with genera^
matters pertaining to hospitalization, administration and evacuation, while
the medical officers attached to G-4 were charged with the hospitalization of
the armies in the field, the location and procurement of sites of fixed hospitals,
negotiations with the French Mission, and broad questions of general policy
which required action by the general staff. ^ Their activities in these matters
conformed to the plans of the hospitalization division of the chief surgeon's
office at Tours. ^ This division, as ultimately organized, administered the
duties outlined above in the manner shown in in the following schedule:^
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 231
HOSPITALIZATION AND EVACUATION DIVISION
(Corrected to November 1, 1918)
A. General administration (one officer).
B. Procurement and construction section (five officers).
Hospital projects.
Transfer of hospital and property from French central authorities.
Off"ers of land and buildings for hospital purposes.
Leasing of land, buildings; etates des Heux.
Hospital plans and construction.
Repairs to hospitals.
Sanitary appliances, plumbing, water, sewerage, fight.
Procurement and distribution of tentage.
Coordination with engineers, railroad and construction, and quartermaster.
Inspection and reports on all included in above items.
Reference maps and graphic charts.
C. Administration and poficj^ section (six officers).
Hospitals:
Centers.
Base.
Camp.
Convalescent (hospitals and camps).
Special.
Red Cross (military and homes).
Boards :
Disability.
Classification.
General.
Inspections:
Action on reports.
Authorization of.
Action on complaints.
Instruction:
Officers.
Enlisted men.
Personnel requirements:
Medical.
Quartermaster.
Engineers.
Etc.
Regulations: General pohcy of.
War diary hospitalization section.
Historical record of hospitalization.
Coordination of administration with other departments and professional section.
D. Personnel and equipment; statistical and liaison section (two officers).
(1) Daily bed report of base hospitals and convalescent camps.
Weekly bed report of all hospitals.
Monthly bed and authorization report of all hospitals.
Statistical tables.
(2) Liaison, chief quartermaster's office reference:
(a) Laundries.
(b) Bakeries.
(c) Fuel.
(d) Subsistence.
(e) Ranges, stoves, etc., for hospitals.
(3) Care of and location of Medical Department units arriving from United States.
(4) Installation of new hospitals, initial equipment and supplies.
(5) Assembh- and shipment of mobile hospitals and mobile surgical units.
232
ADMINISTRATION, AMERICAN EXPEDITIONAKY FORCES
E. Evacuation and transportation section (six officers).
Primary, secondarj', and special evacuation of sick and wounded.
Collection of evacuables of class D and their asseml)ly at base ports for transfer
to the United States.
Transfer and assembly of special classes of patients at special hospitals.
Liaison with Navy Department representatives reference to transfer jjatients to
home ports by Navy transports.
Liaison with French mission reference to disposition American patients in Frendi
hospitals.
Liaison with British mission reference to disposition American patients in liritisli
hospitals.
Liaison with troop movement bureau reference to routing evacuables from hospi-
tals to casual depots, depot divisions, and regulating stations.
Liaison with armies and general headquarters through rei)resentatives at regulating
stations.
Records and statistics of evacuations.
Hospitals trains, personnel, supply, inspections and regulations, requirements and
specifications, auditing of accounts for purchases and rental.
Motor transportation. Shipments from United States, arrivals and shortages in
France, losses, furnishing of transportation and equipment by other agencies.
Records of transportation for identification; registration cards; assignment of
motor transportation in Services of Supply and to arriving sanitary trains.
Records of assembling, repairs, maintenance, and storage of equipment. Person-
nel, supply, inspections and regulations for evacuation ambulance companies.
Service of light, railway, and canal. Construction of cars and appliances for sup-
porting litters. Records of transportation. Obtaining sanitary personnel for this
service.
Liaison with railway transport service and Motor Transport Corps and light rail-
way and canal service.
Under the immediate jurisdiction of the hospitalization division, but not
actually pertaining to it, was the group of professional consultants at Neuf-
chateau. These consultants supplemented the purely official activities of the
hospitalization division by their supervision and direction of the technical,
medical, and surgical services rendered the patients in hospital.^
Instructions concerning the partitioning of military hospitals into two
classes, and the determination of the field of Medical Department responsi-
bility in the control of hospitals under the jurisdiction of the Services of Supply
were published, as follows:
Bulletin No. 29.
American Expeditionary Forces,
Headquarters, Services of Supply,
France, August 30, 1918.
1. All hospitals, e.xcept evacuation and field hospitals, are hereby designated as S. 0. S.
(Services of Supply) formations. These hospitals are divided into two classes. The first
class includes hospital centers and base or special hospitals disconnected from hospital
centers. The second class includes camp or other hospitals serving purely local purposes.
2. Hospitals of the first class have the status of general hospitals and are under the
control of the commanding generals of the sections in which they are located only in the
matter of discipline, guard, inspection, construction, supply, and fire protection. The\' are
under the direct control of chief surgeon, A. E. F., in all other matters, including general
administration, control of personnel, care and evacuation of the sick and wounded, etc.
3. Com manding officers of hospitals of the first class have the responsibility and author-
ity of post commanders in addition to their duty in connection with the general management
ORGAXIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 233
of the hospitals. They are authorized to appoint disability boards for the service of their
hospitals, as provided in section 1, G. O. 41, G. H. Q., A. E. F., 1918. They are authorized
to communicate direct with the American Red Cross convalescent homes and to issue the
necessary orders to send cases to such homes, where accommodations are available.
4. They will apply to section commanders for necessary guards. The commander of
such guard, if a commissioned officer, will report to the medical officer commanding for instruc-
tions as to the character of the guard duty to be preformed and he will exercise no control
over the sanitary formation. If the guard be reported by a noncommissioned officer, it will
be under the immediate control of the medical officer of the day.
5. Hospitals of the second class, including those serving school areas, are under the
control of the commanding generals of the sections in which they are located. This control
will be exercised through the surgeon on the staff of the section commander.
6. Supplies for hospitals, except medical supplies, and allotments for repairs will be
obtained from headquarters of the section in which the hospital is located. Medical supplies
will be obtained by requisition on depots in the manner specified from time to time by the
chief surgeon.
By command of Major General Harbord:
Johnson Hagood, Chiej of Staff.
Official:
L. H. Bash, Adjutant General.
Such of the activities of the American National Red Cross as were con-
ducted in the American Expeditionary Forces and as pertained to mihtary
hospitihzation and supphes were under the control of In the zone of the
armies, the hospitals of this society were under the control of G-4-B; i. e., the
Medical Department element of the fourth section of the general staff.^ When
American Red Cross hospitals were taken over by the Army they became part
of its effective hospitalization service, and as such were under the supervision of
the hospitalization division of the chief surgeon's office.^
Though a large number of possible locations for hospitals had been selected
prior to the transfer of the chief surgeon's office from Chaumont, the need-for
others steadily progressed. When the hospitalization division desired further
procurement it so notified the chief surgeon's representative at general head-
quarters.^ In discharging this duty, the group with G-4 would learn whether
the site proposed had a prior claim upon it either by the French or by another
branch of our service; whether railway facilities (e. g., strength of bridges) were
such that it was readily accessible by trains carrying patients from the front and
by others bringing supplies from the rear; whether the terrain was suitable, if
new construction was planned, or whether available buildings were approxi-
mately satisfactory if use of such structures was contemplated; whether the
water supply was adequate, etc.^ Suitability of the terrain had been a factor
in the early tentative selection of each site, but this was reexamined when
information was received designating definitely the number of buildings that
would be necessary for a specific project.^
Efforts w^ere made in advance to prepare hospital facilities for arriving
troops. To this end surgeons of base sections were directed to make prelimi-
nary arrangements for the care of the sick of incoming troops, and to notify
surgeons of the same concerning the hospitalization and transportation of their
sick pending the establishment of their own infirmaries and camp hospitals.*
In order that hospitals might be established and equipped before the arrival
of troops, the chief surgeon, A. E. F., notified the assistant chief of staff, G-4,
234
ADMIXISTKATIOX, A.MEKK'AX KXPKDITIONAHV FORCES
general headquarters, that he would have to be informed sufficiently in advance
as to the training areas to which the troops concerned would go.* He also noti-
fied the assistant chief of staff, G-3, that each division surgeon should come
to France with the advance party of the division to make the necessary hos-
pital preparation."*
On request of the hospitalization division to the supply division of the chief
surgeon's office, property was shipped to different hospitals without requisition
by the commanding officer of the hospital concerned. Such property included
equipment for base hospitals, complete, crisis expansion equipment,'^ dis-
infectors,'^ and a w^de range of other supphes and material including tentage."
Similarly, the hospitalization division made application upon the American Red
Cross for a variety of supplies and installations (e. g., portable ice machines)'^ and
upon the chief quartermaster for equipment of incoming hospitals w^th such items
as heating stoves,'^ ranges, marmites, hot water reservoirs, cooking utensils,
and messing equipment.'^ Its activities extended into great detail for it formu-
lated lists of the quota of heating stoves and cooking ranges necessary for each
type of unit, itemized the utensils which should accompany each range,
and detailed the equipment of W' ard diet kitchens, of American Red Cross diet
kitchens'^ and specified articles comprising a surgical ward dressing unit,'^
the equipment for a 1,000-bed tent crisis expansion,^** the furniture unit for a
tent ward,^' the furniture unit for a ward containing normal beds,^^ and pre-
scribed in explicit detail the character and quantity of all supplies authorized for
each of the different types of hospitals and for each department of a hospital.
It supervised the organization, selection and provision of equipment for mobile
hospitals, mobile surgical units and other newly created and speciahzed
hospital agencies, as well as of the base or camp hospitals discharging their usual
service, procured authorization for convalescent camps and prescribed their
organization, equipment and operation. It notified the division of labora-
tories of the arrival and assignment of base hospitals in order that the division
of laboratories might make appropriate contact with the respective laboratory
services.^* Some hospitals were assigned to the service of particular classes of
cases, such as cases of psychoneurosis, tuberculosis, bone and joint, cranial and
maxillofacial injuries. The proper selection of specialist personnel for assign-
ment, their supervision and the procurement and distribution of technical
equipment were essential in order that satisfactory results might be attained in
the treatment of patients. That part of the Medical Department which was
charged with the professional care of patients w^as under control of the hos-
pitalization division. It was also necessary that special foodstuffs be provided
and that personnel and equipment suitable for their preparation be furnished."
The provision of labor, fuel, pure water, illumination, and transportation were a
few of the other interests of the hospital service throughout the American
Expeditionary Forces. The hospitalization division was thus charged with the
provision of hospital needs, for their satisfaction, the utilization of resources to
the best advantage, and general administration of the service of hospitalization
and evacuation.^" The fact that over three thousand items were listed among
the supplies required by the Medical Department (most of these pertaining to
its hospital service) illustrated the highly technical character of the professional
services rendered."
ORGANIZATION' AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 235
The hospital division of the chief surgeon's office, A. E. F., conducted its
general administration by means of instructions which were incorporated in
circulars, circular letters and memoranda from the chief surgeon's office, and by
telegrams, letters or telephone conversations with the parties interested. In-
spections were conducted by general inspectors, by members of the hospital-
ization and finance divisions of the chief surgeon's office and by the professional
consultants.^^ Information was also disseminated by the WeeMy Bulletin
published by the chief surgeon's office. Special inspectors constantly visited
the hospitals to instruct the inexperienced in military methods of administration,
to secure the formulation of more accurate reports, and to improve all elements
of the service discharged by those units.
The gravest difficulty which the hospitahzation division experienced arose
from the lack of adequate personnel for fixed hospitals. As stated in Chapter V
of this section, base hospitals were stripped of all available officers, nurses, and
men to form operating and other teams for service in the zone of the armies and
to staff the camp hospitals. Provision of personnel for the last mentioned units,
the chief surgeon declared, was the most difficult problem of the Medical
Department in the American Expeditionary Forces.^"
The hospitalization division compiled two consolidated bed reports, a weekly
report'*^ and a daily report. Both of these were based upon telegraphic
reports of bed status (number of designated beds, both normal and crisis expan-
sion, and occupied and vacant) received from the various stationary hospitals in
the Services of Supply. The purpose of the weekly consolidated report was to
have at hand, not only for the chief surgeon but also for headquarters, Services
of Supply, and headquarters, general headquarters, a complete statement of the
hospital bed situation, in order that the necessity for the additional provision
of hospital beds could be foreseen.
The hospitalization division did not require at first that bed reports of field
hospitals when operating as purely divisional units be submitted to the chief
surgeon's office direct. Later it was required that weekly bed reports be tele-
graphed by field and evacuation hospitals, direct to the chief surgeon's office,
and a form for this was prescribed. Weekly telegraphic bed reports were
required of the chief surgeons of the several armies.^* Considerable difficulty
was experienced in the effort to keep a correct, consolidated report of the hos-
pitals attached to combat units; consequently, on September 21, 1918, the chief
surgeon requested his representative with the general staff to notify him of
changes of status of all hospitals attached to combat units.^^ Frequently units,
such as field, evacuation, and mobile hospitals, arrived in France, opened, closed,
and combined, etc., without word being received by the chief surgeon's office.
The chief surgeon's representative at general headquarters replied to the effect
that in time of active operations compliance with the above instructions would
be very difficult largely because of the difficulties of communication between
the division and corps surgeons and the latter officers and the army surgeon.
Positive orders of general headquarters prohibited telephoning or telegraphing
any information concerning a military location except in code, and code books
were not supplied to any unit smaller than a regiment. The chief surgeon's
representative stated further that this information would undoubtedly be
236
ADMINISTRATION, AMERICAN EXPEDITIONARY' FORCES
furnished when the organization became a smoother working machine, but that
it would have to be suppHed by mail, which was a very uncertain method of
communication.^^
In the late spring of 1918, when our Medical Department took over from
the French the medical service to the rear of our combat divisions,'^ the necessity
arose for having at hand a constantly corrected record of the hospital bed situa-
tion. The hospitalization division of the chief surgeon's office not only had to
assign to a regulating station a definite number of beds for casualties being
evacuated from the front, but also must know to w^hich hospitals farther to the
rear patients in hospitals nearer the front could be cleared. Obviously weekly
telegraphic reports from hospitals would be totally inadequate for the purpose;
consequently, daily bed reports now were required from all stationary hospitals
in a manner similar to that in which the weekly reports were made.^^ It was
this daily report of the bed situation in the hospitals of the Services of Supply,
with which the evacuation section of the hospitalization division was most
concerned.
On the date the armistice was signed the hospitalization division included
41 per cent of the 61 officers then on duty in the chief surgeon's office, a fact
which illustrates the relative extent of its activities.
After the signing of the armistice the hospitalization division was concerned
chiefly with the cancellation of projects, the transfer of patients to base ports
for evacuation to the United States, the closure of hospitals, and the storage of
hospital equipment and supplies.^^
The hospitalization activities of the chief surgeon's office, A. E. F., were con-
tinued along the lines outlined above until the American Expeditionary Forces
were succeeded first by the American forces in France and then by the American
forces in Germany
PERSONNEL
(July 28, 1917, to July 15, 1919)
Brig. Gen. James D. Glennan, M. C, chief.
Col. John L. Shepard, M. C, chief.
Col. Sanford W. Wadhams, M. C, chief.
PROCUREMENT AND CONSTRUCTION SECTION
Col. James D. Fife, M. C, chief.
Col. Arnold D. Tuttle, M. C, chief.
Lieut. Col. Rolf Floyd, M. C.
Capt. John A. P. Millett, M. C.
Capt. Martin D. Mims, San. Corps.
Capt. Harold Rich, San. Corps.
Capt. Donald V. Trueblood, M. C.
First Lieut. Garrett S. De Grange, jr., San. Corps.
First Lieut. Peter A. Lelong, San. Corps.
First Lieut. George E. Russell, San. Corps.
" In this list have been included the names. of those who at one time or another were assigned to the division during
the period July 28, 191", to July 15, 1919.
There are two primary groups— the heads of the division or the section and the assistants. In each group names have
been arranged alphabetically, by grades, irrespective of chronological sequence of service.
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 237
ADMINISTRATION AND POLICY SECTION
Col. Frederick P. Reynolds, M. C, chief.
Col. John L. Shepard, M. C, chief.
Lieut. Col. Leartus J. Owen, M. C, chief.
Col. Shelley V. Marietta, M. C.
Maj. Earnest L. Scott, San. Corps.
PERSONNEL AND EQUIPMENT; STATISTICAL AND LIAISON SECTION
Col. Thomas H. Johnson, M. C, chief.
Lieut. Col. Lucius L. Hopwood, M. C, chief.
EVACUATION AND TRANSPORTATION SECTION
Col. Robert M. Culler, M. C, chief.
Col. George P. Peed, M. C, chief.
Col. Frank W. Weed, M. C, chief.
Lieut. Col. Howard Clarke, M. C.
Capt. James E. Barney, San. Corps.
Capt. Joseph E. Murray, San. Corps.
REFERENCES
(1) Wadhams, S. H., Col., M. C, and Tattle, A. D., Col M. C: Some of the early prob-
lems of the Medical Department, A. E. F. The Militanj Surgeon, Washington^ D. C.
December, 1919, xlv, No. 6, 636. '
(2) Final report of Gen. John J. Pershing, September 1, 1919, 77.
(3) War diary, chief surgeon's office, A. E. F., Julv 28, 1917. On file, Historical Division
S. G. O.
(4) War diary, chief surgeon's office, A. E. F., Julv 21, 1917. On file. Historical Division
S. G. O.
(5) Report from the chief of the medical group, G-4 section of the general staff, G. H. Q.,
A. E. F., to the chief of G-4, general staff, G. H. Q., A. E. F., December 31, 1918.
Subject: Activities of G-4-B, for the period embracing the beginning and end of
American participation in hostihties. Copy on file, Historical Division, S. G. O.
(6) Schedule of organization of hospitalization and evacuation division (corrected to
November 1, 1918). On file, A. G. O., World War Division, chief surgeon's files
(322.32911).
(7) Report from Col. W. L. Keller, M. C, director of professional services, A. E. F., to the
chief surgeon, A. E. F., December 31, 1918. Subject: Brief outline of the organi-
zation and activities of the professional services between April, 1918, and December, 31,
1918. On file, Historical Division, S. G. O.
(8) Letter from the chief surgeon, A. E. F., to surgeon, Base Section No. 2, October 14,
1918. Subject: Hospitalization of incoming troops. On file, A. G. O., World War
Division, chief surgeon's files (322.32911).
(9) Memorandum from the chief surgeon, A. E. F., to assistant chief of staff, G-4, G. H. Q.,
A. E. F., October 13, 1918. Subject: Notification of incoming divisions. On file,
A. G. O., World War Division, chief surgeon's files (322.32911).
(10) Memorandum from the chief surgeon, A. E. F., to the assistant chief of staff, G-3,
October 21, 1918. Subject: Division surgeon with advance party. On file, A. G. O.,
World War Division, chief surgeon's files (322.32911).
238 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(11) Letter from the chief surgeon, A. E. F., to the commanding officer, Base Hospital \o. 14,
A, E. F., July 28, 1918. Subject: Equipment. On file, World War Division,
A. G. O., chief surgeon's files (322.32911.)
(12) Memorandum from the chief of hospitalization division to the chief of the supply
division, July 11, 1918. Subject: Crisis expansion equipment. On file, A. G. O.
World War Division, chief surgeon's files (322.32911).
(13) Letter from the chief surgeon, A. E. F., to commanding officer. Camp Hospital No. 27,
August 5, 1918. Subject: Replacement of Quartermaster Department disinfectors,
On file. World War Division, A. G. O., chief surgeon's files (322.32911).
(14) Letter from the chief surgeon, A. E. F., to the chief of Army Transport Service, June 8,
1919. Subject: Request shipment of portable ice machines. On file, A. G. O.,
World War Division, chief surgeon's files (322.32911).
(15) Letter from the chief surgeon, A. E. F., to the chief quartermaster, A. E. F., July 5,
1918. Subject: Heating stoves. On file, A. G. O., World War Division, chief
surgeon's files (414.2).
(16) Letter from the chief surgeon, A. E. F., to the chief quartermaster, A. E. F., May 31,
1918. Subject: Equipment. On file, A. G. O., World War Division, chief sur-
geon's files (414.2).
(17) Equipment of ward unit, diet kitchens (undated). On file, A. G. O., World War
Division, chief surgeon's files (414.2).
(18) Red Cross diet kitchen equipment list (undated). On file, A. G. O., World War Divi-
sion, chief surgeon's files (414.2).
(19) Memorandum from chief of hospitalization division, chief surgeon's office, A. E. F.,
to chief of supply division, June 19, 1918. Subject: List of articles comprising a
surgical ward dressing unit. On file, A. G. O., World War Division, chief surgeon's
files (442).
(20) List showing " Equipment to be ordered for 1,000 beds-tent crisis expansion, 24 wards."
On file, A. G. O., World War Division, chief surgeon's files (440.1).
(21) "Furniture unit for a tent ward." On file, A. G. O., World War Division, chief sur-
geon's files (440.1)1.
(22) "Furniture unit — ward." On file, A. G. O., World War Division, chief surgeon's
files (440.1).
(23) Statement based on general correspondence concerning hospitalization. On file,
A. G. O., World War Division, chief surgeon's files (322.32911).
(24) Report from Col. J. F. Siler, M. C, director of laboratories and infectious diseases,
to the chief surgeon, A. E. F. (undated). Subject: Activities of the division of
laboratories and infectious diseases, from August, 1917, to July, 1919. On file.
Historical Division, S. G. O.
(25) Report of the activities, hospital center, Vichy; also, report of the activities of Base
Hospital No. 117, prepared under the direction of the respective commanding offi-
cers (undated). On file. Historical Division, S. G. O.
(26) Schematic chart of Medical Department organization, A. E. F. Approved by the
commander in chief, A. E. F., March 6, 1918. On file. Historical Division, S. G. 0.
(27) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April
17, 1919. Subject: The Medical Department, A. E. F., to November 11, 1918.
On file. Historical Division, S. G. O.
(28) Statement based on circulars, circular letters, and weekly bulletins, published by the
chief surgeon's office, A. E. F. On file. Historical Division, S. G. O.
(29) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F. (undated),
Subject: Outline report of chief surgeon, A. E. F. Copy on file. Historical Divi-
sion, S. G. 0.
(30) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919.
On file. Historical Division, S. G. O.
(31) Letter from the chief surgeon, A. E. F., to the commanding officers of base, camp,
and Red Cross hospitals, May 17, 1918. Subject: Weekly bed reports. On file,
A. G. O., World War Division, chief surgeon's files (632.1).
ORGANIZATIOX AND ADMINISTRATIOX OF CHIEF SURGEON'S OFFICE 239
(32) First indorsement, from the chief surgeon, A. E. F., to commanding officer, 164th
Field Hospital Co., June 20, 1918; on letter from the commanding officer, 164th
Field Hospital Co. to the chief surgeon, A. E. F., June 16, 1918. Subject: Daih-
report of patients in hospital. On file, A. G. O., World War Division, chief surgeon's
files (632.1).
(33) Letter from the chief surgeon, A. E. F., to the chief surgeon. Third Army, January 17,
1919. Siajject: Weekly telegraphic bed reports. On file, A. G. O., World War
Division, chief surgeon's files (632.1).
(34) Letter from the chief surgeon, A. E. F., to chief surgeon. First Army, January 17, 1918.
Subject: Weekly telegraphic bed reports. On file, A. G. O., World War Division,
chief surgeon's files (632.1).
(35) Memorandum from the chief surgeon, A. E. F., to Col. S. H. Wadhams, M. C, G-4,
G. H. Q., A. E. F., September 21, 1918. Subject: Information regarding change
of status of hospitals. On file, A. G. O., World War Division, chief surgeon's files
(320.23).
(36) Memorandum from Col. S. H. Wadhams, M. C, to the chief surgeon, A. E. F., Septem-
ber 30, 1918. Subject: Information regarding change of status of hospitals. On
file, A. G. O., World War Division, chief surgeon's files (320.23).
(37) War diaries, chief surgeon's office, November 16, 1918, to June 30, 1919.
(38) Report of the Medical Department activities of the Third Army (undated), by Col.
J. C. Grissinger, M. C; also, letter from the chief surgeon, A. F. in F., to the com-
manding general, A. F. in F., December 30, 1919. Subject: Report from July 1
to December 31, 1919. Both on file. Historical Division, S. G. O.
13901—27 16
CHAPTER XV
THE DIVISION OF HOSPITALIZATION (Continued)
HOSPITAL CONSTRUCTION; PROCUREMENT
CONSTRUCTION
Despite the possibility of procuring from the French certain buildings
that could be adapted to hospital purposes, it was apparent to the Medical
Department, A. E. F., from the outset that these would have to be supple-
mented by new construction.^ Even before the arrival of headquarters,
A. E. F., the erection of a barrack hospital was commenced in the debarkation
camp at St. Nazaire.^
An important factor in expediting the development of our needs in this
matter was the fact that the French did not have in the training areas which
they were to turn over to our troops sufficient hospitalization to meet our
needs, and it quickly became essential that we then construct buildings of
our own.^ A set of plans for a large hospital of barrack type had been sent
to France when the staff of the American Expeditionary Forces went over-
seas, but these were found to be wholly impracticable.^ The ground plan
of the unit as defined by the War Department called for three times as large
an area as did the plans eventually adopted for a unit with the same number
of beds in the American Expeditionary Forces. Also, it prescribed porches,
a sewerage system, extensive plumbing and heating appliances and other
features which could not have been realized with the limited resources avail-
able in France. Neither lumber nor the labor necessary for their construction
were procurable overseas.^ Accordingly, as soon as it was ascertained that
the plans prepared by the War Department could not be utilized, an assist-
ant to the chief surgeon, A. E. F., after collecting suggestions from various
medical officers commanding base hospitals of the American Expeditionary
Forces, formulated plans for construction and layout which were more com-
patible with our resources.^ Many of the good features that had been de-
veloped by our Allies were incorporated in the plans which he developed, but
he also considered in their formulation the general layout of the Letterman
General Hospital in San Francisco. The plans now formulated were made
the basis of hospital construction in the American Expeditionary Forces.
PLANS FOR A BASE HOSPITAL, TYPE A
The plan for the layout and for the buildings to be erected for each base
hospital, whether located separately or in conjunction with others, was desig-
nated that of a type A unit.^
To conserve wear and tear on personnel and to facilitate administrative
control, the area to be covered by these hospital units was reduced to a mini-
mum, consistent with safety from fire.- To economize in heating, lighting,
structural material, etc., and to centralize and standardize the units, only 20
241
242
ADMINISTRATION, AMERICAN EXPEDITIONAR V FORCES
feet of space was allowed between most of the buildings. From an adminis-
trative and clinical standpoint this concentration proved preferable, and,
though it increased the fire risk, not a single serious fire occurred in any of
these units. ^
The type A unit required a frontage of 850 feet and a similar depth, its
normal layout comprising 3 rows of buildings, divided by suitable intercom-
LMRINE.
ABLUTION BLDQ.
IBftRRACKSl I I
|e>^RRACKS[
PEKSONNEL DINING HALL
WlClS DESTRUC-g
TOR SHED J
INCINERATOR^
Imeoical stores I
y c — '
LATRINE
□
ELECTRIC L1G,HT PLANT
iDISINftCTOIll
ir> o
5 O
(_» "0
u. Z
^^
uJ
uJ —
UJ ^
I WARP I
WARD
|_ ^ j [OFFICERS WARP |
OFFICERS
LATRINE I— J
AHO bathLj=[
OFFICERS QUAR-
I I TERS
I Q.M^STORES I
IPATIENTS Dm. RIC
Ol
iPATIENTil
KITCHEN I
PATIENTS DIN. KM.
DISPENSARY AND CLINIC
ol
lOPERATINQ
[and xray
laboratory AND MOR(<UE
RECREATION HALL
I PATIENTS I
RtCEIVlN&A
(~EVAC. [=L
ADMINISTRATION*
OFFICERS QTR5. & DINING HAU
WA R D
WAR D
1
in uJ
« o
UJ >
WARD
<
I
NUR5E5 DIN-
ING ROOM AND
=i KITCHEN~|=^NUR$FS QTftS^j-
rilNURiES ()TRT^j=(HUR«S QTKS.I
PNUB5C5 R
=fno^rT
NUR2E3
LATRINE
& BATH
H]
850
Fig. 21.— General layout of hospital unit, type A (base hospital), with wards 20 feet wide. Demountable buildings. In
a hospital center one recreation hall and one disinfector were provided for each two hospital units; the nurses' recreation
club was omitted when a central nurses' recreation club was provided
municating roadways and walks. ^ The central row of buildings included
those pertaining to general service such as administration, reception of patients,
baths, operating and X-ray section, clinic, and dining room. On each side of
this central row of buildings was a block of 5 or 10 wards, dependent upon
their size, and in rear of these sufficient space for the erection of tents, the
crisis expansion, which in prolongation of the several wards would provide
additional bed capacity in emergencies.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 243
In the type A unit the ward buildings were of two sizes; * the scarcity of
building material, and the different contracts made it necessary to have in one
part of France buildings entirely different from those in another part.^ Thus
the dimensions of one ward used was 20 by 164 feet; of another, 36 by 156 feet.
The number of patients per ward varied, of course, with its size, normally
being about 50 for the narrower ward and double that number for the wider
one. In addition, the wards provided space for the necessary administrative,
ABLUTION bLO^.
I 6ARRACK5~1 | |
PER50NN£L
Idininq hall] I barracks"!
-FECES DE5TRUC- O-^
TOR SHED J
INCINERATOR^
LATRINE
djELtCTRlC LIQHT PLANT
jDISINFLCTOR]
I 1 c
Z
< lO
X uJ
UJ lO
<r, O
2§
u. Mi
\-
a
u r
> t-
oc —
UJ J
UJ
cc r
o
WARD
WARD
WARD
I I [OFFICERS WARD
H L-l ,
OFFICERS
LATRI
& &AT
OFFICERS QUARTERS
().M.& MEDICAL 5T0RES
— 1 KITCHEN I—,
I— DININQ HALL —
OPERATING, X-RAV
AND CL1N\C
LABORATORY AND MORQUE
RECREATION HALL
L!: REC* EVAC
OFFICERS QUARTERS AND OINIHQ HALL
ADMINISTRATION
WARD
WARD
WARD
Z
<
0-
X »0
uJ o
UJ
"5 O
^ z
O
uJ —
I I
NURSES mm
ROOM* KITCHEN
j=^URSE5 QTrT^ j::|NUR5ES QTRS|
LATRINE
& BATH
==i NURSES QTRS[=1^"
NURSES RECREATION CLUB
850
Fig. 22.— General layout of hospital unit, type A, with wards 20 feet wide. Permanent buildings. In a hospital center
one recreation hall and one disinfector were provided for each two hospital units; the nurses' recreation club was
omitted when a central nurses' recreation club was provided
culinary and toilet facilities. Twenty of these buildings (10 when the wider
wards were used), half being on each side of the central administrative or
chnical group, provided accommodations for 1,000 patients, the normal capac-
ity of these units. Extension of each ward by tentage, the crisis expansion,
doubled this capacity, and gave accommodations for 1,000 emergency beds.
In the corners of the general plan were located the quarters of the officers,
nurses, enlisted men and accommodations for the isolated or psychiatric cases. ^
244
ADMINISTRATION-, AMERICAN EXPEDITIONARY FORCES
Originally the plans for type A units provided for a recreation hall in the
central row of buildings, and a space had been designed for such a structure.
The American Red Cross imdertook to install, equip, and operate these build-
ings, and in the fall of 1917 sent to France 5,000,000 feet of lumber for this
and other purposes.^ Building material, however, was so scarce that the general
staff, A. E. F., requested the American Red Cross to transfer this material to
FtCE5 DE5TRUCT0R
5HED-2_
LATRINE.
ABLUTION BLDG
I6ARRACK5I
PERSONNEL DINING
HAUl
LATRINE
□ electric light PLANT
INCINERATOR
DI5INFECT0R
I I
(ft
o
^ o
Of o
Of z
o
< z
lO ft.
K
0FFICERS|—|_
LATRINtIF
AND BATH
WARD
WARD
WARD
WARD
OFFICER'5
WARD
OFFICERS
QUARTERS
Q.M.Y MEDlCXU
STORES
J~L
= KITCHEN AND =
=1 DINING HALL =
OPERATING X
AND CLINIC
LAB.rh AND
MORGUE
RECREATION HALL
PAT BATM =
It RtCJtVACriJ
1 1 / aoministratiohX
WARD
WARD
WARD
WARD
WARD
r
2 O
ac o
(J
o z
ec t
UJ >
«o >
-r
* O
lU
o. <
lO a
I I
NURSES DINING
RM. 8i KITCHEN
Nil
NURSES
LATRINl
NUR5ES RECREATION
CLUft
850
Fig. 23.— General layout of hospital unit, type A, with wards 36 feet wide, 156 feet long. In a hospital center one recrea-
tion hall and one disinfector were provided for each two hospital units; the nurses' recreation club was omitted when
a central nurses' recreation club was provided
the American Expeditionary Forces, engaging itself to construct these buildings
from material that would be obtained later. ^ This created a regretable situa-
tion, because at no time did sufficient material become available for the Amer-
ican Expeditionary Forces to fulfill this obligation.^ Accordingly w^hen the
American Red Cross realized that fact, it again undertook the provision of
recreation buildings, construction being effected by the engineers, but, when
hostilities ceased many hospital units lacked their authorized recreation huts.^
ORGAXIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 245
AD:\riXI8TKATI0X, AMERICAN EXPEDITIONARY FORCES
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 247
O X
■(N
uj O
ol
III
O
u.
u.
o
O
u.
"o
>
O
y-
a;
o
o
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248
AD.MIXISTKATIOX.
A^r?:RI('A^■ expkditioxaky forces
J I
O- c
Si
o
O
Is
f40UiJ.'iivd iHbi3H nnj.
2
o
H
2
o
o
llJ
u
4^
V
UJ
5
: ^ - -
1 ^ ^
i> — —
5 Z
-4 O
V
II <
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 249
This was a graver matter than might at first appear, for, in the absence of
legitimate diversions otherwise obtainable, the facilities of the recreation
buildings had a noteworthy influence in promoting the morale of the hospital.
&0-0-
A
RACKS
V
OFFlCtR OF Day
(>'-(>"x ll'
R.ECEIVIN(i AND EVACUATlNC^ HALL
69-0" X 20'- 0"
NOrCi- ALL PAR.TIT1ONJ a HiqH
NO FLOOKy
OUILOIHtf "OT LINtD
Fig. 31.— Receiving and evacuating hall, hospital unit, type A; for use with demountable buildings
J4'- o"
-WOOD OR COMCHlTt FLOOH,-!
-COMCRETt FLOOR -
-WOOD OR CONCRETE FLOOR.-
UNOREiiinq ROOM /C^^^^ fU5S 3 WASHmq ''v ) ORESSINq KOOM i
r\, 24'-o"x i8'-o- r\\ ^ 2v-o"xi8'-o"
MOTeS- ALL rARTITIOMS 8-0 UIQH
MO Lmm(j- OB. ceiLmq
Fig. 32.— Receiving and evacuating hall and patients' bath, hospital unit, type A. Permanent type
note: ALL PARTITIOMS O'-O Hlt^H
Fig. 33.— Patients' bath, hospital unit, type A; for use with demountable buildings. Permanent type is shown in
Figure 32
In order to standardize and simplify construction, each hospital w^as
designed on the principle of using only portable wooden huts with floor dimen-
sions of 20 by 100 feet, or any huts built of other materials but approximating
these dimensions and obtainable in Europe.^ These standard units as designed
were complete in every particular.^ Most of the type A hospitals w^ere built
of wood. Some, where local resources permitted, were superior, and, especially
ADMIXISTRATIOX, AMEHTCAX E:XPEDITI0X AR V FORCKS
A
5
o
O 'sO
HI
I !
I i I
I :3 I
If I
I ^ I
! NC
si
if
in those units constructed by English
or French contractors, tile, brick, sheet
steel, and concrete were frequently
used.^ The buildings that were made
of wood or sheet steel (Adrian barracks)
were composed of unit mill-fabricated
sections 10 feet high and 83^ feet wide,
each side of the average buildings which
had a length of 100 feet comprising 12
sections. These sections consisted of
side frames and roof trusses to which,
when set up, the walls and roof panels
were bolted. They were bolted together
while flat on the ground, then raised
to a vertical position and temporarily
secured until the side and roof panels had
been bolted. The wall panels, 10 feet
long and 4K feet wide, were provided
with exterior and interior board walls,
the latter having a smooth finish.
Roofs consisted of boards covered with
tar paper; floors and ceilings, of planks.
The windows, though adecjuate, were
comparatively small, for glass was scarce
and substitutes frequently were neces-
sary. Among these substitutes for glass
were plain or oiled cotton fabrics, and
an isinglass preparation on thin wire
mesh. The isinglass preparation proved
unsatisfactory in the damp climate of
France.^ The first type A hospital,
which was at Bazoilles, was reported
as one-third completed in December,
1917.2
The component parts of the huts were
interchangeable and were so divided that
it was possible by adding sections to erect
a building of any length desired; for ex-
ample, ward buildings in the type A unit
measuring 20 by 164 feet.^-^ Changes in
width were made with more difficulty
but could be effected by an adjustment
of paneling or by doubling up buildings.
Considerable latitude was thus possible
in the dimensions of buildings.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 251
Erection of these huts was relatively simple and, if the military situation
so required, they could be taken down (no nails having been used in the assem-
blage of the component parts), shipped and reerected on another site in a mini-
mum space of time.- They left much to be desired, when compared with
permanent structures, but met requirements, though the great scarcity of lumber
frequently necessitated the use of green timber which resulted in some warping
of the walls. ^ The great advantages which structures of this type presented
were availability, mobility, quickness of erecting, and low initial cost. The
/V foTol
y
Kic. 3').— Nurses' recreation club, hospital unit, type A; demountable
average price paid for them was $2,000. These huts, frequently called barracks,
had been in use among the armies in France and had proven satisfactory.^
They became the backbone of our hospitalization program.
In order to preserve symmetry and to facilitate assembly it was prescribed
that as far as possible huts should all be of similar design and of the same dimen-
sions in any one unit. The demand for these structures gradually became so
great that it was necessary to comb every available European market for build-
ing materials for them, and, as a result, a half dozen different materials for hos-
pital huts eventually came into use.^
BIMCH- 6H£LveS
I P CLINICAL LA
\y i5'x2o'
3
Of whatever material they were built
the huts had the same design and .
dimensions as those prescribed for the
portable wooden huts.
Soon after the Medical Depart-
ment began its construction program
general headquarters, A. E. F., was
confronted by a severe shortage in
the building material necessary for its
many construction projects.^ Accord-
ingly, in an effort to retrench, it
reexamined the plans for hospitals and other buildings and ordered a re-
duction in the space allowed for living quarters of officers, nurses, and
enlisted men.^ The chief surgeon's office acceded to this reduction except
in so far as it affected nurses.^ Though it strenuously opposed diminution
of the modest allowance that had been made for them, this reduction in
their quarters was enforced until April, 1918,^ when one room, 10 by 14 feet,
was allowed for each 2 nurses. Covered passageways connecting wards,
clinical buildings and dining rooms were eliminated as mentioned above, but
n07£ :- WINDOWS AHD DOORS OF MOKijtJE. AUTOPSr
JfOOM 70 0£ JCR££N£D.
COI^CRtTC FLOOHi THUOiKjHOUT.
-Laboratory and morgue, hospital unit, type A;
for use with demountable buildings
252
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
the plans successfully resisted further pruning except where the units were
grouped in centers. Certain further reduction was then possible; for example,
some of the psychiatric or isolation buildings were eliminated and the general
staff strongly advocated elimination also of unit administration buildings and
storehouses.^ Fortunately it receded from this position, otherwise it would
have been impossible promptly to equip the frequent drafts of outgoing
patients.^
As discussed below, under procurement, the French were primarily charged
with coordination of construction, several agencies often seeking the same
site.^ After the approval of the French had been received for the construction
of a project, the chief surgeon recommended to the assistant chief of staffs
note: DAR.K. ROOM TO S£ LlflCD TWO S/P£S WITH LEAP OK IKON TO A HSIQHT OF T FT. INTER.IOR. OF ROOlyl TO BE
PAINTED BLACK. IfVALLi AND CEILIN<f OF OPEHATINCf AND FLUOROSCOPIC ROOMi TO BE PAINTED WHITE-
Fig. 37.— Operating and X-ray building, hospital unit, type A. This plan was adopted December 15, 1917, and waste be
used only when demountable buildings were to be used. The permanent type is shown in Figure 38
G-4, general headquarters that such construction be effected. The latter
then directed the commanding general, Services of Supply, to proceed with
construction of a designated number of hospital units at a certain place. The
Engineer Corps then proceeded with the construction, much of this being
effected, under engineer control by civilian contractors. Even when buildings
were taken over from the French it was almost always necessary to have exten-
sive additions, repairs or alterations made before they were suitable for our
hospital use.^
During the early period of our hospital construction it was necessary to
secure from the French a promise that their Engineer Corps would construct
the necessary railroad sidings and loading quais.^ In view of their shortage
of man power and materiel, such promises were difl&cult to obtain. On the
whole, however, without the assistance at this time of the French, who took
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 253
PLANS FOR HOSPITAL CENTERS
The necessity for doubling, or in
emergencies quadrupling, the size of a
base hospital with relatively small in-
crease in the number of the per-
sonnel serving the unit, suggested
that further economies might be made
by grouping these organizations into
hospital centers.^ Though the expedient
c a
immediate and actively helpful interest in the prosecution of our program, we
would have experienced great difficulty
in having ready sufficient hospitals to
shelter the large number of wounded
of the following summer and fall.^ As
it was, very few of our barrack hos-
pitals were ever entirely finished.^ It
was necessary to occupy them long
before the construction work was com-
pleted and wounded were moved into
the wards when these furnished little
more than protection from the ele-
ments.^ During the warm weather this
situation was not serious, but after cold
weather came on it was only the early
termination of hostilities that pre-
vented very great suffering: Thousands
of casualties were sheltered in unfloored
and unheated tents.' The personnel
of base and camp hospitals frequently
assisted in the building or modification
of the structures which their respective
units utilized and continued to perform
this work even after patients were ad-
mitted. Convalescent patients and,
later, labor troops also assisted and
were an important factor in the efforts
to overcome the shortage of civilian
labor.^ The situation was fraught with
great anxiety to those charged with the
provision of hospital accommodations
for the rapidly increasing numbers of
casualties, but in view of the difficulties
encountered it was not surprising that
the construction program was never
fully realized.'
offered many advantages
254
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
HALL
a' % zo'
OI5PEN5A(l.Y
zV-d' X 20- o"
a'x lo'
0B.E.5SINq ROOM
zo' X 20'
trt, tAt.NOSt A THROAT
CLINIC
20' X,
DtNTAL
LABORAT0R.Y
I0'-o"xi2'-o" DENTAL
OPERATING ROOM
lb' X zo"
WAITING ROOM
32 X 10'
ALL FAKJITlONi 6 fT. MI<iH tXCSPT AS NOTED
Fig. 39. — Dispensary and clinic building, hospital unit, type A; to be used for demountable building only
96'- 0"
DENTAL LABORATORY
AND OPERATINq
20' X 24'
la
0ISPEN5ARY
is'xzV
fLAP COUNT
MEDICAL STORAGE,
le' X 36'
[(RESSINqS
16' X 12'
CLINIC
EYE, EAR, HOSE, THROAT
20' X 12'
WAITING ROOM
le' X za'
efT AS ftCTCC
ROOM FOR.
5URQICAL DRES5INQS
is' X 46*
V
Fig. 40.— Clinic and surgical dressings building, hospital unit, type A. This building was to alternate with the operating
X-ray, and clinic building shown in Figure 38; that is, when there were more than one type A unit in a hospital center,
half were to have buildings according to this plan, and half according to the plan shown in Figure 38
CANNED Q00D5
z'xiz'
meat room
12' me'
VEQETABLES
7'xIE' /
BREAD ROOM
tz'% \z'
uJ
88' ±
KITCHEN
43' X 40'
BRAIN BOARP I "I I 1^ I I
<e
0. o
PAY COOKS
16' X 26'
MIQHT COOK
i6'x 13'
Fig. 41.— Patients' kitchen, hospital unit, type A. Temporary type
ORGAXIZATIOX AND ADMIXISTEATIOX OF CHIEF SCRGEOX'S OFFICE 255
liJ t X
CZ2
MbtH ^ 9
1\
z.
-1 X I 9>^ — iVo
■o - u I
3: ^ Lii_ J
3^
13901—27
17
256 AD^riXTSTRATIOX, AMERICAN EXPEnTTIOXA H V FORCES
ORGANIZATION ANT) A I):MINISTRATI0N OF CHIEF SURGEON'S OFFICE 257
dominant consideration causing its adoption was
as far as possible for the shortage
in personnel, h}^ reducing staff and over-
head demands to a niininium. It was
jjlanned as early as September, 1917, to
group from 2 to 20 hospitals and a con-
valescent camp at each of these formations
and that the largest of them should have
from 30,000 to 36,000 beds.^
The geometrical layout of the indi-
vidual unit admirably fitted in with any
grouping scheme. When a site capable of
acconnnodating a number of the type A
units was selected, an initial survey, with
particular reference to contours, was made
by the Engineer Corps, A. E. F., and the
grouping eventually adopted with reference
to the most adaptable conformation to these
contour lines. ^ By doing this and by bear-
ing in mind that the majority of the build-
ings were but 20 feet wide, a considerable
saving in piering materiel or excavation
work was effected. The location of the
units, moreover, was made with a view of har-
monizing the administration of the center.
In consultation with those in charge
of construction, representatives of the chief
surg(>on's ofHce worked out and adopted an
appropriate layout for each center.- The
primary requisite was the decision as to the
location and adequacy of railroad sidings,
all of which had to be newly installed, and
the frontage of units on these sidings. The
requirements for the administration and
supply of these centers were made b}^ pro-
viding suitable extra buildings for that
purpose. Central water, sewerage and
lighting systems, garages, storehouses, etc.,
also had to be installed. In fact, the larger
centers, in some of which we had projected
a capacity of 20,000 beds, approximated
the creation of a veritable city with all its
a (• c ess o ry re q u i r e ni e n t s .
PLAXS FOR CAMP HOSPITALS, TYPE B UNITS
The layouts of the type A and type B
units were highly similar, differences
hetween the two consisting chiefly in
the size and completeness of the buildings employed.
the need to compensate
Z Z (D oi
< uJ - O
S Z X o
A
Kl\ O ^ °
§5. -
< § S o2
uJ oc ^ 0
o . , o
s: o J
V
V
258
ADMIXISTHATIOX, AMKHKAX EXPHDniOXAin' FOHCKS
Typo B hospitals wore niucli loss olahorato than thoso of typo A, for it
was iiitondod that they would provide only the barest hospital noeessities.-
Though each of these was a fairly complete working plant with operating room,
X-ray laboratory, etc., they wore not designed to give definitive treatment.
Each type B unit required an area 600 feet square and consisted of a central
block of service buildings and two lateral rows of five wards each.^ Each of
the wards was 100 feet long by 20 feet broad and accommodated 30 patients. In
each of these units also, space was reserved, in prolongation of the wards, for
crisis expansion by tentago, or w^iere permanent expansion was desired, by
huts.^ The normal capacity of the units was 300 beds but with the crisis
expansion a total capacity of 1,000 beds was provided.
T3'-pe B hospitals were never grouped, but were scattered througiioiit
France, to moot needs arising in isolated commands and in training aroas.-
ROOM FOR NIQHT MEN
30'-0" X 20'-0"
TWO BARRACKS RtqUIRED , ONE TO HAVE. ROOM FOR MiqHT MEN.
NO FLQOR.S. aviLP/Nq NOT LINED.
Fio. 40.— Barrack building, hospital unit, type A. Demountable
DININQ
7a'- a" X
HALL
19'-8''
AO FLOOIZ,
STOfllS
KITCHEN
13'-E"xt9'-8"
C<WC«£T£ fLOOK.
bUILPI*fq HOT LIHtP
Fk;. 47.— Personnel dining hall, hospital unit, type A. Demountable
They were a very important element of American Expeditionary Forces hos-
pitalization and proved to be quite indispensable. On the day the armistice
was signed 66 of these units were in operation.^
QUALITY OF CONSTRUCTION WORK
The quality of the construction w^ork performed in our various individual
hospitals and hospital centers varied from good to bad, seemingly conforming
to the individual experience and efforts of the officer locally in charge of con-
struction.^ Many of the projects were turned over to French or English
contractors who secured the best results. The work performed on some of the
hospital projects, particularly those in the advance section, was highly unsatis-
factory, being of a makeshift character with apparently no attention to detail
or desire to make the best of the material at hand.- It was early pointed out
and particularly emphasized by the chief surgeon's office that the first requisite
OKGAXIZATIOX AND ADMIXISTRATIOX OF CHIEF SUEGEOX'S OFFICE 259
mi
2
?\ i
7^ t
COXVALESCEXT CAMPS
in any construction program was the building of good roads, and the develop-
ment of the water and sewer systems. In many of the
projects these desiderata were overlooked, construction
of buildings being started before any work had been
done upon roads. Hospital sites, when this procedure
was followed, soon became small seas of mud, and
])rogress was materially handicapped. As late as Dec-
ember, 1918, many of the essential roadways in these
units were in inexcusably bad condition.^
In those parts of France where our base hospitals
wore erected, cloudy days prevailed for the major part
of the year and for this reason north-south orientation
with east-west exposure to sunlight was not as impor-
tant a factor as it would have been in more sunny
localities, nevertheless, wherever practicable, this or-
ientation was practiced.
To avoid excessive piering, all buildings were
arranged on parallel lines with the general layout con-
forming as far as possible to contour lines.
Recognizing the shortage in material, and the great
difficulty of obtaining in adequate quantities many of
the essential articles required in a great construction
project of this nature, every conceivable refinement
was eliminated from these type X and type B hospital
units. ^ For example, porches were not included. Be-
cause of the prevalence of inclement weather in
France, particularly in the territory in which we were
recpiired to hospitalize, it was believed that overhead
l)rot(M'tion in the form of covered passageways along
the front of the ward entrance and connecting up the
central group of clinical and mess buildings should be
])rovided. These were prescribed in the plans as
finally adopted, but were never installed in any of
the units, owing to scarcity of lumber. Because of
the fact that plumbing material could be procured in
very limited amounts only, plumbing fixtures were
reduced to a minimum. Buildings were heated by
stoves; fecal matter was disposed of by the pail
method and incineration.
V
With the speeding up of troop movements early _i
in the summer of 1918, it was soon realized that fixed
iiospitalization, as its acquisition was then progress-
imr, could not keep pace witii the arrival of troops. To meet this situation it was
decided to provide convalescent camps in the vicinity of and as part of large
260
ADMINISTKATIOX, AMERICAN KXI'KDITIOXA m' KOKCES
hospital centers to which men not yet lit for duty, but w ho no \ouv:v\- re(|iiire(l
careful hospital treatment, could be sent pending their fitness lor return to duty.'
In these camps the men were provided with shelter. The bed space was limited
but the food was good, and the men were given a certain amount of work and
exercise to fit them for their forthcoming duty. The assistant chief of staff, G-4,
general headquarters, on June 1, 1918, authorized the construction oi- establisli-
ment by tentage of these convalescent camps, on the ratio of 20 per cent of our
total bed capacity.'" Many of these camps were in operation upon the conclu-
sion of hostilities on November 11, 1918, and it was through their operation
-91 - 10 ±-
■« /f^SORTINq ROOM^
/H 19-0" X l9'-8" f\
DRYiNq ROOM
19'- 8" X 40'-0"
M0T£3: COnCHETL FLOOK. THUOUCHOUT
ALL PAK.riTtONS FULL HtlOHT
MoT TO »£ if<£D
19-B X 0-0
SOILED CLOT
19'-8"x
Fig. 49. — Disinfector building, hospital unit, type A, for use only when demountable barracks were used
only that we were able to provide accommodations for the battle casualties
occurring during; the summer and fall of 1918.-
TENTAGE
The intended use of tents in connection with fixed hospitals in the American
Expeditionary Forces w^as to permit a rapid expansion of the bed capacity of a
hospital during stress ^ and to shelter patients in convalescent camps.^ As
stated above, in the plans of both type A and type B hospitals the permanent
wards were so situated as to leave space
JJ DRtSSmQ
Xl ROOM
Fio. 50.— Ablution building, hospital unit, type A.
moun table
Be-
at their outer ends for ward tents.
Thus patients in the permanent wards
so far improved as to be no longer in
need of close supervision by ward sur-
geons and nurses could with safety be
removed to the contiguous tent wards,
leaving space for the more seriously
sick or wounded.
The kinds of tents used were two European models, the marquee and the
Bessonneau and our own Medical Department w^ard tent." Contracts were
made with three companies in France for 10,000 Bessonneau tents." This is a
double-wall tent, capacity 26 beds normal, 30 beds emergency. It is well lighted
with windows, and since stoves may easily be installed, this tent is quite warm.
If supplied with electricity, suitable walks and roads, this tent makes an admir-
able ward as it is warmer than the barrack ward. The Bessonneau tents did
not begin to arrive until about the 1st of October, and there were only 800 of
them in use on November 11." Three thousand marquee tents had been deliv-
ered by the British, and deliveries were coming in at the rate of 50 per day at
the time of the signing of the armistice."
ORGAN l/.ATIOX AN J) ADMINISTRATION OF CHIEF SURGEON'S OFFICE 261
262 ADMINISTHATIOX, AMKHK AX EXPEDlTroXAHV FORCES
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 263
Because of the inability to obtain an adequate number of either the marquee
or Ikvssonneau tents, practically all hospil als with crisis expansion made use of all
three of the kinds of tents referred to. However, the greatest use was made of
the United States Army ward tent in connection with the convalescent camps,
since the patients therein had convalesced to a point where they needed little or
no strict hospital treatment.'^
It was necessary to employ approximately 2,500 American ward tents in
convalescent camps in the fall of 1918, and when the armistice was signed the
chief surgeon's office had placed in use practically all its resources in tentage.^^
The question might logically be asked why type A units were not constructed
on a 2,000-bed capacity basis from the start, and thus eliminate the necessity
for tentage. The reasons for this were obvious. There was not sufficient
[jj FECES DESTRUCTOR
EXPANSION AREA
FOR,
HUTS OR TENTS
350 BEOS
WARD Z=
PATHS 4 WIDE
OPERATING
AND CLINIC
11 ir— ir
BATM HOUSE.
AND DISINFECTQR
PATIENTS MESS —
II ilLJ
□
ADMINISTRATION AND
OFFICERS^UAHnWS | — |
EXPANSION AREA
FOR.
HUTS OR TENTS
350 BEOS
DINING HALL
HOSPITAL PEHSOWHEL
Fig. 53. — General layout, hcspital unit, type B (camp hospital)
building material on hand in France to permit of this action; and even had
there been, it would have been unnecessary and expensive installation.- In
l)i'oviding for this expansion by the use of tentage we divided our sources of
supply and retained a mobility in crisis materiel that w^as essential in expanding
at places requiring it, and, as the name implies, these crises occurred only in
certain phases of our cambat acitvities. By expanding only during them, over-
head and upkeep expenses were reduced materially.
In this connection, the chief surgeon, A. E. F., expressed the opinion
in March, 1919, that a crisis expansion of 1,000 beds made a hospital too un-
wieldy, and that it should be no greater than 500 beds.^
264
ADMINISTEATIOX, AMERICAN EXPEDITIONARY FORCES
I o — ' o
U. M
uj UJ O
-J B J<
_I ,
3 o 9
-_9X,.0-,1'
0-0?-
O
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(rj.H!>i3H nnj HOii
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O i o S
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 265
UJ (SI
« JX
°'?
«o'2
z o
2 o
3 O
Z 2
f^iivM xHt>u t>na
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8
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AD.MIXISTKATIOX, AM?:RICAX KXI'EDITIONAHV FOHCES
J^rior to the api)r(>val, on J
PROCUREMKXT
\iigust 13, 1917, of a program authoiiziiii;
73,000 beds,'2 the chief surgeons' office, A.
E. F., had steadil}' been ac{[iiirinfr existin<r
hospitals from the French, for it was impos-
sible to construct buildings in time to meet
the immediate needs of our troops wlio had
begun to arrive in June, 1917.^ But when
the program authorized June 1 became effec-
tive a progressive system of hospital pro-
curement was adopted.^ As it was evident
that any attempt to administer our base hos-
pitals under canvas would prove impracti-
cable, it was essential that the chief sur-
geon find buildings in which base hospital
units could operate, and during many months
he took over the most suitabh' available
structures that could be foimd. These ac-
commodations could be provided by (1) tak-
ing over military hospitals from the Frencii
Army; (2) leasing the most suitable buildings
available. Buildings in the first category
were transferred by the French to the limit of
their capacity. No reasonable request was
ever refused, and among the hospitals thus
transferred were some of the very best in
France, but evidently it was neither expe-
dient nor possible that that country deplete
its own resources of this character unduly
in order to meet our needs. ^ From our own
point of view, too, there were definite objec-
tions to taking over French military hospi-
tals, despite the willingness of France to help
us to the utmost. One objection was the
fact that most of these hospitals w^ere small
institutions of from 25 to 300 beds, and that
the limited personnel authorized for our serv-
ice could be used much more economically
in operating much larger units. Moreover,
these hospitals, w'idely scattered, were
served largely by French residents of the com-
munities where they were located. When we
took over such a formation it was necessary
either to lease neighboring quarters for our
personnel or to diminish its bed capacity by
quartering them in a part of the hospital
itself. As explained more fully in Chapter
XVI, the bed capacity of our base hospital
ORGAXIZATIOX AND AI)^[IXISTRATI()X OF CHIEF SURGEOX'S OFFICE 267
in order to compensate to a degree for the low percentage of Medical Depart-
ment personnel authorized on the priority schedule by the general staff,
had been increased to 1,000 and made capable of expansion in emergencies
to double that size.'^ It was recognized from the outset that only under
unusual circumstances could French hospitals be used to advantage, except
FECES DBSTRUCTOR. P
□ HQ
LATRINE CiROUP „ „
INCINERATOR
JMM cimic
bHOn AND
0FECES DESTRUCTOR
D BD
X J; LATRINE QROUP
|piwiN<j H*TH ipmiNq HAU^ — ^ — p~
Idininq HAiil Ipwrnq hail| — | — p"
IPATH HOUStl |8ATH HOUsT^ -| — ^
OFFICERS LATRINE -T
AND 6ATH
I I I I □
140
PARADE. QROUND
APPROXIMATELY I060' X 50o'
NOTSS:- LOCATIONS OF ADMIN 1ST RATIOfI BUILOIN<i, OFFICtKS QUARTERS, OFflCtRS MESS,
TRtATMENT BARRACK AND OFFICERS' LATRINE * OATH TO Ot DETERMINCP IH EACH
SPtCIFIC CASE. ,11
THIS LAYOUT CONTEMPLATES THE USE OF MARQUEE UNITS (l7 K 3S - S TO A IVAXo) ^
BUT EITHER BESSONNEAU TENTS ( lO' X 56- 2 To A WARD) OR U.S. HOSPITAL TENTS (ik' X 50-
l TO A ward) may be used WHERE THEY ARE MORE ACCESSIBLE.
THREE INCH CONCRETE FLOORS TO BE USED IN ALL BUILDINqS SHOWN WITH FLOORS
WHIH CONCHETE MATERIAL IS AVAILABLE LOCALLY.
LEGEND
URINALS '
f~~l WOODEN HUT5
I I TEMT5
Pir,. 59.— General layout, hospital unit, type C (convalescent camp), 2,000 beds
to meet transient needs or to form a nucleus around which barrack extensions
could be constructed. Practically all of those which were transferred to our
service w^ere much increased shortly after they came under our control.'*
Therefore, in attempting to meet hospitalization requirements, medical
officers charged with the procurement of buildings quickly turned to the adap-
268
ADMINISTRATION, AMERICAN EXPEDITIONA H V FORCES
11^
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2.
O-'
X
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ILl
<o r J.
^ 111 o ^
_ uJ —
SOS
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V
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IC
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oo
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u. CM
tation of suitable buildings. These, however,
were comparatively few , most of them having
been preempted by the French or by her
allies, Belgium, Italy, and Portugal, and were
being utilized either for hospital purposes or
as habitations for French and Belgian refu-
gees. Many were occupied by Red Cross
and other volunteer aid societies from all
parts of the world. Under these circum-
stances, when the United States entered the
field it was found that the majority of possi-
ble hospitals discovered or offered were lack-
ing essential and rudimentary hospital facili-
ties or potentialities.^^ Common defects were
inaccessibility, poor state of repair, lack of
sanitary plumbing, small size and wide dis-
persion of buildings. Nevertheless, anticipa-
ting the arrival of large bodies of troops from
the United States necessitated the procure-
ment of existing buildings. This was pushed
to the utmost, though most buildings taken
over required alterations, additions, and re-
pairs in order to make them suitable for ho.s-
pital use.'^ On September 27, 1917, the chief
surgeon, A. E. F., reported in some detail the
difficulties which would be encountered in
adapting existing buildings to hospital needs.
On the 17th of the following month he wrote
the Chief of Staff as follows
It is recognized that in the present emergency
anything that offers shelter for patients must be used.
However, the use of such buildings as the French have
offered can be considered only as an emergency meas-
ure and in no wise meets, from our point of view, the
demands for adequate hospital facilities.
Among the buildings taken over were
school buildings, hotels, chateaux, barracks,
factories, and even stables. School buildings,
as a rule, were among the earliest buildings
utilized. Almost invariably they were
unsatisfactory; few had running water, sewer
connections, or toilet facilities. Under the
French law, when schools were requisitioned
for militaiy purposes the teaching person-
nel, which were furnished living quar-
ters in the building, had to })e allowed to
ORGANIZATIOX AND ADMINISTEATIOX OF CHIEF SURGEON'S OFFICE 269
X
I-
i
o
Do
ROOM
X 14-'
S'o
CO
8:
270
ADMlXrSTRATIOX, AMERICAN EXPKDITK )X A K V KOIUKS
lotaiii them.
The result was that in the same buildin^js there would he wards
for patients, quarters for personnel, and livinf;
:/ I ' =^ quarters for French civilians — arrangements
that were inevitabh^ unsatisfactory to all
concerned.
Objections to the use of hotels as iios-
pitals rested on other grounds.'^ As prac-
tically all the best and most suitably located
buildings of this class had been taken over
by the allied governments, those available
were very lai'gely summer hotels without
heating facilities. Usually, they had insuffi-
cient water and very limited plumbing, and
they required many alterations before they
were suitable for hospital purposes. Also the
rate of rentals was very high. In addition,
when a private })uilding was taken over for
military purposes the owner was allowed by
law to reserve certain parts of the building;
also the law required that a building should
be returned to the owner in the same condi-
tion as when taken out of his control.^ The
latter provision necessitated refurnishing
these structures at high cost and removing
all improvements or additions which might
have been installed. Furthermore, they were
difficult to administer and extravagant in
their requirement of personnel.
With many differences in detail, the diffi-
culties incident to the use of other buildings
were comparable to those pertaining to hotels.
Barracks, because of their large ward space,
were more easily administered, generally
speaking, than the hospital established in
other preexisting structures.''^
When we desired an existing French hospi-
tal, or buildings being utilized by the French
as a hospital, a representative of the chief sur-
geon inspected it and if it was deemed suit-
able, a request by letter was made upon the
French for its transfer to the American Ex-
peditionary Forces, through the chief of the
mission attached to headquarters of the
' y* I '-^ American Expeditionary Forces.^ The date
— of transfer was decided upon and the
French thereupon notified us when we could
take control. As a rule, the Medical Department of the American Expeditionary
OROAXIZATIOX AND ADMIXISTKATIOX OF CHIEF SURGEOX'S OFFICE 271
Forces usually took over in these buildings all the hospital property that was
still serviceable.^
Careful inventories, which included the conditions of buildings and lists of
the property contained therein, were prepared by representatives of the American
and French Armies, acting jointly.- These inventories were prepared in quad-
ruplicate and each interested party was furnished a copy. Record of these
transactions was maintained in the chief surgeon's office, A. E. F. From this
beginning gradually developed the service later known as "rents, requisitions,
and claims," which later took charge of all such transactions and became the
custodian of these records.- The personnel of the chief surgeon's office which
had been gathered together for this purpose was transferred to that service when
it was officially put into operation.
i ^
ij s I
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Fig. 6.3.— Kitchen, liospital unit, type C
The acquisition of schools, hotels, and other buildings not previously
occupied as hospitals was accomplished through leases obtained generally
through a local representative of the French Army.- Rarely was it necessary
to resort to military requisition, although in a few isolated cases this proved
nocessar}'.-
Securing private buildings was not unattended with great difficulty; on the
contrary, much opposition was encountered even after they became available to
us. Endless bickerings with proprietors and directors led to almost endless
coirespondence w^hich could result only in the greatest amount of delay in
making the buildings over into hospitals.'^
In July, 1918, when our hospitals in France provided beds for but 5.7 per
cent of our troops there, the French were asked for buildings sufficient for 45,000
beds, because of the difficulties in the way of construction.^*' The beds requested
were to be in buildings located either on our line of communications or, if not
there obtainable, then in the more remote parts of France. The central bureau,
Franco-American relations, w^hich controlled all such requests, unofficially
13901—27 IS
272
ADMINISTRATION, AMERICAN KXFKDITIONAH V FORCES
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ORGANTZATIOX ANB ADTkllXTSTRATTOX OF CHIEF SL'RGEOX'S OFFICE 275
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PLAN OF A TWO TLNT WAR.D
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Fig. 72. — Plan of a two-tent (Bessonneau) ward
Fig. 73.— Showing heating arrangements in a Bessonneau tent
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 277
278
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Fic. T.T. — Plan of a inarciuoe tent ward of three tents
Fic. 76. — Showing heating arrangements in a marquee tent ward
OKGAXIZATIOX AND AD:MTXTPTRATI0X OF CHIEF SUEGEOX'S OFFICE 279
Fig. 77. — Perspective of closet in a marquee tent ward, showing construction
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280
ADMIXISTHATIOX, AMEKICAX EXPEDITION A UV FORCES
answered all the requests made by furnishino; lists of buildings that were quite
different from those desired, thus necessitating our rejecting many buildings as
being unpractical for our purposes.'^ Because of the urgency of the situation,
Genei-al Pershing addressed the Premier of France as follows:
General Headquarters,
American Expeditionary Forces,
France, August 16, 191 S.
Monsieur Georges Clemenceau,
President du Conseil, Paris.
My Dkak Mk. President: General Ireland, the chief of our Army Aledical Service,
has brought to my attention the vital need of extra hospital facilities, which we must liave
as soon as possible. At present we have at the most but 6 per cent of beds for our troops
in France, and it is agreed that 10 per cent is the lowest safe margin. In view of the
increased program of troop arrivals, it will be impossible for our hospital construction to
keep pace with the influx of troops, so that it is necessary to call on your people for an
increasingly large amount of hospital space in buildings already constructed. On July 13
a request was made for 45,000 beds in buildings either on our line of communications or,
if this were impossible, in the more remote parts of France, and a specific request has been
made for various hotels, schools, and military barracks which have been inspected by our
medical officers. A copy of this list is herewith attached, with the addition that we have
made a request for and need the Ecole de Legion d'Honneur at St. Denis.
In accordance with instructions No. 9 of February 12, from the office of the Under-
secretary of State, these questions have been handled entirely with the central office of the
Franco-American relations in Paris. General Ireland informs me, however, that he fears
that it will be impossible to get the quick action needed. Experience has shown that any
specific request for buildings which have been inspected by our medical officers are usually
met by a counterproposition which, after a certain length of time, has been made to the
American officers in charge of this work. May I not suggest that the central bureau of
Franco-American relations hasten to make inspections of a number of buildings suitable
for hospitals with a view of meeting, without delay, the increasing necessity for largely
increased accommodations for our sick and wounded? Just now, time is the all-important
factor, and anything you may be able to do to enable us to meet our early requirements
will be most highly appreciated.
I regret having to bother you with this matter, but in view of its importance I bring
it to your attention, knowing well that with your powerful assistance we will achieve the
results that we desire in the quickest possible time.
Permit me to express my thanks for the splendid efforts made by your officials to aid
us in every way.
With highest personal and official regards, believe me,
Very sincerely yours,
(Signed) Johx J. Pershing.
At the instance of the Premier, the French mission now submitted a list
of public buildings which, it w^as stated, had been reserved for the American
Medical Service.^* The French Government wished to divide equally the
burden of hospitalization among the territorial departments and among the
different classes of buildings in the departments. Long lists of buildings were
sent at intervals to the chief surgeon through the French mission, but for
various reasons (such as the delapidated condition of some of the buildings,
their small size, their remote location) many buildings included in these lists
had to be rejected.'^ Buildings thus offered fell, in the main, into four classes:
Military casernes, public or private hotels, schools, and miscellaneous buildings
which comprised factories, storehouses, etc. The amount of buildings thus
OKGANIZATIOX AND ADIMINI^TRATIOX OF CHIEF SURGEON'S OFFICE 281
offered potentially i-epresented beds to the number of 155,422.'^ Possible
accommodations for many more had been taken over by us, but these were
found unnecessary after the armistice had been signed.
After the signing of the armistice the buildings which had been accepted
from the French on November 11 were returned with the exception of one at
Lucon,"^ but procurement of buildings continued for several weeks in order to
provide hospital facilities in new locations conformable to the new conditions
which arose by the armistice/^
On November 27, in reply to a request for a conference concerning relin-
quishment of buildings used for hospital purposes, the commanding general.
Services of Supply, wrote the commissioner general for Franco-American war
affairs as follows:
2. Owing to the indefinite information regarding the military situation at present, it
is not believed that a conference on this subject should be undertaken at this time, but this
can be undertaken as soon as a definite plan of demobilization of the American Expe'ditionarv
Forces has been made.
3. Although a reduction of the necessity for hospitalization has been made from 15 per
cent to per cent, since November 11, yet this reduction comes at a time when there are
approximately 190,000 patients in hospitals, and we can not operate upon the lesser figure
until these cases are returned to duty with their units or evacuated to States.
4. All offers of buildings made on the various lists have been definitely accepted or
rejected. Since August 1 these have amounted to approximately 125,000 beds, of which
approximately 51,000 have been accepted and approximately 74,000 rejected. Since this
time many buildings that have been accepted have been returned through the French mission
as being necessary for hospitalization, and from time to time many others will l)e returned
when it is definitely ascertained that they will not be needed and that no troops will be located
ill the localities concerned.
5. Your attention is called to the fact that every consideration has been given to dis-
lurl)ing schools as little as possible, that wherever possible schools have been evacuated
and returned, and this plan will be continued. Attention is also called to the fact that it
will be only necessary to requisition buildings in those localities where troops may hereafter
be stationed and where no buildings exist. This number will be reduced to a minimum.
6. Regarding the matter of deoccupation of the older establishments obtained during
the early part of the American occupation, attention is called to the fact that considerable
construction in barracks, or water supply, electric lighting, sewers, roads, drainage, etc. has
been done, and it is believed that on this account these should be retained until the last
to be evacuated.
7. It will not be necessary to requisition buildings not already in process of organization,
l)ut it is desired to occupy many hotels on the Mediterranean and in the Pyrenees, in which
it is expected to treat convalescents. These properties were obtained through amicable
lease in the main. But few requisitions were made, and their retention is in the main
agreeable to the owners. In other localities no buildings have been taken or will Ijc taken
where hospitals have not been organized and operated.
REFERENCES '
(1) Wadhams, S. H., Col., M. C, and Tuttle, A. D., Col., M. C: Some of the early problems
of the Medical Dei)artmcnt, A. E. F. The Military Surgeon, 1919, Washington D C
xlv, No. 6, 636. ' '
(2) Report of activities of G-4-B, medical group, general staff, G. H. Q., A. E. F., Decem-
ber 31, 1918, by Wadhams, S. H., Col., M. C. On file. Historical Division, S. G. O.
282 ADMIXJSTHATION, AMKHICAX KXPKDITIOXAHV lOHCES
(3) Letter from the chief surgeon, A. E. F., to tlie cliief engineer, A. E. F., September 17,
1917. Subject: Design for a l,()00-bed crisis expansion, A. E. F., Army Hosi)ital,
Type A. Copy on file, A. G. O., World War Division, chief surgeon's files (322.3291 1 1
(4) Plans on file, Record Room, S. G. O. 632 (A. E. F., France).
(5) Letter from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, March 2S,
1919. Subject: Plans for hospitalization. On file. Record Room, S. G. O., 632
(A. E. F., France).
(6) G. O. No. 46, H. A. E. F., October 10, 1917.
(7) G. O. No. 58, G. H. Q., A. E. F., April 18, 1918.
(8) Letter from the chief surgeon, A. E. F., to the chief engineer, A. E. F., September 30, 1918.
Subject : Plan of type B (300-bed) camp hospital unit. Copy on file, A. G. O., World
War Division, chief surgeon's files (329.32914).
(9) Memorandum for the assistant chief of staff, G-4, G. H. Q., A. E. F., from Col. S. H.
Wadhams, G. S., May 24, 1918. Subject: Hospitalization. Copy on file. Historical
Division, S. G. O.
(10) Memorandum for the commanding general. Services of Supj)ly, A. E. F., from the
assistant chief of staff, G-4, G. H. Q., A. E. F., June 1, 1918. Coi)y on file. Historical
Division, S. G. O.
(11) Report on hospitalization and evacuation of sick and wounded, for the military l)oard of
Allied supply, April 10, 1919, by Brig. Gen. J. R. Kean, M. D. Cojiy on file, A. G. 0.
World War Division, chief surgeon's files (314.7).
(12) Memorandum for the chief of staff from the chief of operations section. General Staff,
G. H. Q., A. E. F., August 11, 1917. Subject: Hospitahzation. On file, A. G. 0.,
World War Division (632) .
(13) Report of the activities of the chief surgeon's office, A. E. F., from llic arrival of the
American Expeditionary Forces in Europe to the armistice, )>y the chief surgeon,
A. E. F., March 20, 1919. On file. Historical Division, S. G. O.
(14) Memorandum for the chief engineer, A. E. F., from the chief surgeon, A. E. F., Septcml)('r
20, 1917. Copy on file. Historical Division, S. G. O.
(15) War diar}-, chief surgeon, A. E. F.
(16) Letter from the commander in chief, A. E. F., to the chief of French Mission, Tours,
Juh' 13, 1918. Subject: Hospitalization. On file, A. G. O., World War Division,
chief surgeon's files (322.32911).
(17) Letter to M. Georges Clemenceau, President du Conseil, Paris, from General Pershing,
August 16, 1918. Subject: Hospitalization. On file, A. G. O., World War Division,
chief surgeon's files (322.3291).
(18) Memorandum for the as.sistant chief of staff, G-4, S. O. S., from the chief surgeon,
A. E. F., August, 13, 1918. Subject: Hospital program, A. E. F. On file, A. G. 0.,
World War Division, chief surgeon's files (322.32911).
(19) Letter from the chief surgeon, A. E. F., to the chief, French Military mis.sion, S. 0. S.,
November 23, 1918. Subject: Hospitalization. Copy on file, A. G. O., World War
Division, chief surgeon's files (329.32911).
(20) Letter from the commanding general, S. O. S., A. E. F., to the commissioner general,
Franco-American war affairs, Noveml)er 27, 1918. Subject: Hospitalization. Copy
on file, A. G. O., World War Division, chief stirgeon's files (329.32911).
CHAPTER XVT
THE DIVISION OF HOSPITALIZATION (Continued)
HOSPITALIZATION OF SICK AND WOUNDED
Though the hospitalization division of the chief surgeon's ofhce, A. E. F.,
was charged with the supervision of all hospitals of the American Expeditionary
Forces, this volume gives but brief consideration to the mobile hospitals which
served armies, corps, or divisions in battle or in training areas. These mobile
hospitals are discussed in Volume VIII of this history, which considers field
operations of the Medical Department. Though they were a part of the
entire hospital provision of the American Expeditionary Forces, their procure-
ment did not form a part of the hospitalization program as that term was
t(>clinically understood. The hospitalization program referred essentially to
the provision of fixed formations — i. e., base and camp hospitals and convales-
cent camps — and only when qualified by some explanatory phrase was the term
"hospital program" made to include the field hospitalization of the American
Expeditionary Forces. One reason for this was the fact that most of these
Held units were authorized by Tables of Organization in certain numbers for
each body of troops and were supposed to accompany them automatically
except as this provision was modified by priority of the shipping schedule.
Certain units — e. g., mobile hospitals and mobile surgical units — were not
originally prescribed by organization tables but were authorized by general
orders and were provided according to tactical needs and resources. Thus,
mobile hospitals were authorized ' but not supplied ^ in the proportion of one
per division. But the prime reason why the field units were not included in
the hospitalization program proper was the fact that they were expected to
give only very temporary accommodation to casualties. They had to clear
as rapidly as possible in order to receive new arrivals from the fi'ont and to
be prepared to clear and move on very short notice in order to accompany
the troops they served. Therefore their bed capacity could not be considered
a part of the total that should be available at a given moment. Nor did this
program technically include infirmaries established by the American Red
Cross along the line of communications, nor the infirmaries with capacities of
from 10 to 50 beds which the military forces established and staffed with
local personnel for care of the slightly sick and injured belonging to regiments
in camps, small groups serving in towns, or other detached commands. These
latter infirmaries were established where neither the number nor the severity
of the cases required the establishment of a camp hospital and were under
the administrative control of the local commander. All of these services
though not included in the hospitalization program proper were nevertheless
under the general supervision of the hospitalization division of the chief
surgeon's office.
283
284
ADMTXISTRATIOX, AMERICAN EXPKDITION'AH V FOHCER
Therefore, though the term "hospitalization," as technically understood
and as utilized in the following text, was applied to onl}^ fixed formations,
and among these essentially to base and camp hospitals, including militarized
American Red Cross hospitals and naval base hospitals receiving Army casual-
ties, and to convalescent camps, it was used also in another and more general
sense, being applied to the entire hospital system of the American Expedi-
tionary Forces from the battle areas to the sea. This general system is here
briefly described, before a discussion of hospitalization in its more technical
sense is undertaken, in prder that there may be given a coherent view of the
subject in its entirety, and that the position therein of the fixed hospitalization
may be defined.
HOSPITAL FACILITIES AT THE FRONT
The following units, which are discussed at some length in Volume VIII,
comprised, during the World War, the sanitary train of divisions, corps, and
armies:^ 3 field hospitals, motorized; 1 field hospital, animal-draw^n; 3 ambu-
lance companies, motorized; 1 ambulance company, animal-drawn; 8 camp
infirmaries; 1 medical supply unit; 1 mobile laboratory (added later). The
normal capacity of the field hospital was 216 patients.^
When we entered the World War field hospitals were equipped similarly
throughout and in accordance with existent tables of organization, but the
unlooked for conditions it was necessary for them to meet in France necessi-
tated additions to this equipment.^ Thus to one of the four divisional field
hospitals additional surgical equipment w^as issued in order that it might func-
tion on a larger scale as a surgical hospital. To one of the other hospitals was
added the equipment for the treatment of gassed patients.
Field hospitals were utilized according to current needs, their service and
disposition differing considerably^ in the several divisions under changin<r
circumstances. Often two hospitals were combined and here patients were
sorted, distributed if need be to the other field hospitals with the division, or sent
to the rear.
Usually one of the divisional field hospitals was used to sort patients and
to care for the wounded, one received sick, and another gassed, while the fourth
hospital was held in reserve or was used to supplement one of the others.'
Sometimes one of these hospitals was used for the nontransportable surgical
cases only. When facilities permitted, this last-mentioned unit was reenforced
by a mobile surgical unit, extra bedding and equipment and, rarely, by surgical
teams. The hospitals carried their own tentage, but when opportunity offered
occupied buildings in suitable locations.
As stated above, mobile hospitals were authorized in the proportion of
one per division in action ^ but were not provided in that number.^ Only
12 were actually utilized.^ These units were devised to care for the serious
surgical cases and therefore were provided with appropriate equipment and
with 120 beds for nontransportable wounded. The equipment to a large degree
was surgical, and included X-ray apparatus, sterilizing apparatus, operating
room supplies, electric lighting plant and mobile laundry. The}' cared for the
seriously wounded who could not be transported to the rear without grave
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 285
danger. They were distributed b}^ the army surgeon to augment the service
of field or evacuation hospitals. One was used for a time for the treatment,
in the army zone, of cranial cases only.^ These units, though small, were
complete, required but a few hours for their establishment or packing, were
readily transportable.
Mobile surgical units were smaller organizations transportable on three
trucks each provided with an operating room, sterilizing, X-ray and electric
light equipment. They also were assigned by the army surgeon to supplement
the hospitals of division, corps, or army.^
The sanitary train of a corps consisted of four field hospitals, four ambu-
lance companies (all motorized) withdrawn from the replacement divisions.''
These units cared for and evacuated patients from the divisional hospitals in
front of them to the army units in their rear and cared for the disabled while
en route.
The sanitary train prescribed for an army was the same as that of an
Infantry division.^ It was supplemented by the mobile hospitals and mobile
surgical units above mentioned, and by evacuation hospitals which were
authorized in the proportion of the two per division.^ However, that number
of evacuation hospitals was never reached, though equipment for 16 of them
was sent overseas early in the war.^ Each evacuation hospital originally
provided for 432 patients but in the summer of 1918 their capacity was increased
to 1,000 beds and the equipment of these units already in France expanded
accordingly.^ In emergencies their capacity was further increased. These
units under control of the army surgeon were located at railheads, where they
received from the front all patients that were to be sent to base hospitals on
the line of communications. They were supplemented by other army hospi-
tals which cared for gassed patients by three neuropsychiatric hospitals and
by certain militarized units furnished by the American Red Cross. ^
HOSPITAL FACILITIES IN THE SERVICES OF SUPPLY
The hospital facilities provided in the interior, in France, England and
Italy, but b}^ far to the greatest degree in France, were base hospitals (including
one pertaining to the Navy), hospital centers, convalescent camps, camp hos-
pitals, American Red Cross military hospitals, American Red Cross hospitals,
and American Red Cross convalescent homes
BASE HOSPITALS
Prior to the World War, base hospitals were the Medical Department
units of the line of communications designed to receive patients from field and
evacuation hospitals, as well as cases originating on the fine of communications,
and to give them definitive treatment.^" It was intended that base hospitals
would be well equipped for such treatment and that there would be sent to
the home territory only patients requiring special treatment or whose condition
might be such as to warrant the opinion that they were either disabled per-
manently or not likely to recover within a reasonable length of time.
Base hospitals had been organized originally with a staff of 20 officers,
46 nurses, and 153 enlisted men.'" This staff was increased in the latter part
286
AD.MINI.STKATIOX, A.MKHKAX KXl'KDniOXAin" lOMCKS
of 1917, then consisting of 35 officers, 100 nurses, 200 enlisted men and a valuable
but limited number of civilian eniplo^^ees, viz, dietitians, technicians, and
stenographers."
Base hospital units were allowed in the shipping schedule in the proportion
of four to a division, but were displaced to a considerable degree by combat
troops, with the result that from the time our forces began to conduct operations
on a large scale, in the summer of 1918, their number was inadequate and
remained so until after the armistice was signed.- In many instances their
equipment was not received for many months after having arriving overseas.
HOSPITAL CENTERS
In the American Expeditionary Forces the controlling factor in the prepa-
ration of plans for base hospitals was economy in personnel and material. But
there was every necessity for further economy in personnel, administration,
and supply; consequently, these hospitals were grouped, in so far as local
conditions permitted, into "centers of hospitalization," or hospital centers,
as they came to be called.
CONVALESCENT CAMPS
Before headquarters, A. E. F., authorized the establishment of convales-
cent camps, on June 1, 1918,'^ there were in nearly all our military hospitals
in France many patients whose medical or surgical treatment had been com-
pleted, but whose physical condition was such that their attending surgeons could
not return them to their commands for full duty.*^ Since there was every
necessity for keeping as many base hospital beds as possible ready for the
reception of patients from the front, the substandard men referred to above
frequently had to be evacuated long distances to other hospitals where the
demand for beds was not so insistent. Particularly was this necessity for a
clearance true of the base hospitals located nearer to the front. To relieve
this condition and, at the same time, to increase hospital facilities generally,
the chief surgeon, A. E. F., recommended on May 17, 1918,'^ that convalescent
camps be authorized and constructed, one in the vicinity of each hospital
group. Its size in point of bed capacity was to be rated at one-fifth that of the
hospital group it was to serve.
The cases to be sent to a convalescent camp were those for whom medical
and surgical treatment, beyond dispensary care was no longer necessary, but
who needed a more or less brief period of graded physical training and rehabili-
tation suited to their condition. This physical rehabilitation was to be under
an experienced medical officer; but line officers assisted by noncommissioned
officers, temporarily or permanently disabled for further duty, were to be used
for commanding and drilling provisional companies. Thus over-hospitiliza-
tion and loss of discipline would tend to be obviated.
Though it was proposed to use barracks for convalescent camps, no objec-
tion was held to the use of tents, the stipulation being, however, that there
should be an increase in floor space over that for ordinary barracks and that
there should be no double bunks.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 287
As mentioned above, this proposal of the chief surgeon was approved by
headquarters, A. E. F., June 1, 1918. The bed capacity of convalescent camps
was included in the normal capacity of the hospitals with which they were
connected.
CAMP HOSPITALS
It is neither necessary nor advisable to place all cases originating on the
lines of communications in base hospitals; all such cases do not require the more
extensive or definitive treatment for which base hospitals are intended; further-
more, it is axiomatic that sick and injured soldiers should receive hospital care
just as near their commands as is compatible with the condition of the patients
and with the exigencies of the military situation. Therefore, in the American
Expeditionary Forces for each divisional training area and camp, a camp hos-
pital was provided, where all local cases could be admitted, only the severely
sick and injured requiring a better quality of treatment being transferred to
base hospitals.
As early as July, 1917, the chief surgeon, A. E. F., attempted to secure
authorization for personnel for these important units but his recommendation
was disapproved, on the ground that personnel from the divisional sanitary
trains would be available to fill this need.^ Experience proved that such a view
is based on a misconception of the problem presented. To employ the sanitary
train personnel in this way prevents the training in preparation for combat,
which is just as essential for sanitary units as for those of the line. Moreover,
divisions were constantly changing from one area to another and to have followed
the plan proposed by the general staff, A. E. F., would have resulted in aban-
doning these excellently-equipped sanitary formations until the next division
chanced into the same area.^ The necessity for providing and authorizing
sanitary personnel for the camp hospitals is one of the outstanding lessons of
the experience gained in this war.^
CAPACITY OF HOSPITALS
BASE HOSPITALS
The pre-war bed capacity of a base hospital was 500.^*^ This was based upon
the fact that in a war of motion it frequently would become necessary with the
progression or recession of the battle front to change the locations of base hospi-
tals along lines of communications. Thus mobility was a factor which had to be
borne in mind in connection with the equipment of a base hospital. However,
in France, there was every indication that the location of a given base hospital
would be relatively fixed; consequently, in his study of hospitalization for the
American Expeditionary Forces, the chief surgeon, A. E. F., on August 2, 1917,
stated that the personnel of a base hospital, with proper material, could reason-
ably well care for 1,000 patients, and that it was his intention to increase the
equipment of these units and to operate them with a capacity of 1,000 beds
each."* This increased capacity was effected in General Pershing's project of
the rear which he sent by cable to the War Department during the following
month.
13901—27 19
288
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
In addition to the increase in capacity of base hospitals from 500 to 1,000
beds, a crisis expansion of 1,000 beds was provided for by the use of tents. ^' Thus
there came to be two kinds of bed capacity: normal and crisis expansion. It
was only upon the normal bed capacity, however, that the ratio of hospital beds
to troops was based.
HOSPITAL CENTERS
Since hospital centers comprised an aggregation of base hospitals, their
separate bed capacities w^ere not fixed. They possessed an elasticity, in so far
as hospital beds were concerned, that was limited, on the one hand, by available
ground where buiklings constructed in situ were to be used, and, on the other
hand, by available buildings where these were to be used, for example, at Vichy.
At a number of points several— i. e., from 2 to 11— base hospitals were
grouped physically in hospital centers, and accommodations for much larger
formations were under construction when the armistice was signed.
The largest of these hospital centers were at Mesves, Mars, Savenay,
Bordeaux, Bazoilles, Rimaucourt, Beaune, Allerey, Nantes, Brest, and Limoges,
whereas in Paris the hospitals were grouped administratively as one center.
The principal hospital centers in existing buildings were Vichy (hotels), Toul
(casernes), Clermont-Ferrand, Vittel-Contrexeville, and Cannes.
CAMP HOSPITALS
Camp hospitals had an authorized capacity of 300 beds and crisis capacity
in emergencies,'^ but some were much larger; e. g.. No. 26, which served the
first replacement depot at St. Aignan, and had a capacity of 2,200 beds, and
Camp Hospital No. 52 at Le Mans, which had a capacity of 2,300.^*^
AMERICAN RED CROSS HOSPITALS
American Red Cross military hospitals and convalescent homes were a
valuable asset to the American Expeditionary Forces, particularly in Paris,
where up to the time of the Chateau-Thierry operation the Medical Department
was not allowed to establish hospitals.^ Their bed capacity was variable.
After July 1 the Medical Department did establish many hospitals in and
around Paris and on November 1 1 arrangements were under way by which we
would have had 20,000 beds in that city.^' Other notable Red Cross hospitals
were at Beauvais, Juilly, Jouy-sur-Marne, Toul, Froidos, and Glorieux, as well
as convalescent homes for officers, nurses, and men.
RATIO OF BEDS
In the early summer of 1917 the hospitalization question concerning the
American Expeditionary Forces naturally divided itself into two distinct prob-
lems: Hospital accommodations to meet the immediate needs of the sick of the
American troops in France; the provision of hospitals for the care of the wounded
to be expected when our troops became actively engaged in the front line.
As it obviously was impossible for us to construct hospitals in time to meet
our immediate needs, the French were asked to relinquish to us accommodations
of this character wherever they were needed.^ To these requests they willingly
acceded.
OUTLmL MAP OF f 2.A/iCE:
OHOWINQ HO^ITAL CLmi:Il&
OmC£ Ot- TriI.C«ltt SUROLCWi .
A t ^■
SiCALfc- 1 : 1,250.000
SO U. <54-5& -27
Fig. 79. — Outline map of France, showing the location of the rarious fixed hospitals of tlie American Expeditionary Forc(<s
13901—27. (Face p. 288.;
ORGAXIZATIOX AND ADMINISTEATIOX OF CHIEF SURGEON'S OFFICE 289
Alter the French had met the initial needs of our service in the transfer of
hospital facilities, they urged that we prepare a hospitalization program in
w hich we would outline what we considered necessary to meet both present and
future needs." They did not seek to influence the terms of the program, but
sought chiefly to learn the number of beds that the American Army would
require as well as their geographical distribution in order that they might pro-
mote our projects and coordinate a similar plan of their own with ours. Accord-
ingly, on July 8, 1917, representatives of the chief surgeon's office, A. E. F., and
of the French Medical Service held a conference whose purpose was the study
Fig. 80.— American Red Cross Military Hospital No. 21, Paignton, Devon, England
of a project to provide 50,000 beds, which it was the intention of headquarters,
A. E. F., to locate in France during 1917.^^
This number of beds was considered by the chief surgeon as being too small
to use in connection with a project, in view of the inevitable delay in securing
sites and completing necessary construction work; therefore on August 2 he
reconnnended in its stead that not less than 100,000 beds be provided, using
500,000 troops as a basis for his estimates. At this time the general staff
was willing to agree to the chief surgeon's estimate in part only; that is to say,
no fault was found with the proportion of the number of beds to be supplied,
but, since it was believed that there had been an inadequate time for mutual
research and study, there was a possibility of error which would be minimized
290
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
in a basic number smaller than 500,000 troops. Therefore, the ai)pli('ation of
the chief surgeon's percentages was made to a force of 300,()()() men, thus
viding for 73,000 beds.
Since there must be a correlation of the provision of beds and personnel
with which to operate them, and further, since the bringing of personnel to
France had been placed on a phase basis, it is not surprising that headquarters,
A. E. F., should adopt a similar basis for hospitals. This was done in mid-
October, 1917.^ Hospital beds were now allowed on the basis of 10 per cent of
Fig. 81.— American Red Cross Coiu ali bcriit Hospital No. 101, Lingficld, Surrey, England. (For officers)
our total forces in Europe for a given phase, with an additional 10 per cent for
troops in combat. It was anticipated by the general staff that not more than
four of the five corps concerned would be engaged simultaneously, consequently
the above allowance would approximate 15 per cent hospital beds for ordinary
needs and 25 per cent for maximum needs, in addition to the beds of the divi-
sional field hospitals.
The provision of base hospitals according to the successive increment of
forces was tabulated as follows:
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 291
American Expeditionary Forces hospitalization program — estimated beds required
Phase
Second .
Third..
Fourth .
Fifth..
Sixth...
Troops
Line of communication troops..
Army troops and aviation
First Corps..
Army troops and aviation
83.000 8.300
"22,0001 2.200
174,000 17, 400
25.0001 2, .500
Total __ 304, OOOlSO, 400
Line of communication troops.. 73, OOOj 7,300
Second Corps j 178, 000 17, 800
.\rmy troops and aviation ["SUOOOj 3, 100
liinc of communication troops.. _ I .52, OOOi .5,200
Third Corps .1177,000 17,700
"32,000 3,200
41,000 4,100
177,000 17,700
"29,000 2,900
27,000 2,700
177,000 17, 700
"21,000 2,100
16,000 1,600
Army troops and aviation.
Line of communication troops.
Fourth Corps
Army troops and aviation
Line of communication troops.
Fifth Corps..
Army troops and aviation
Line of communication troops.
Total
Convalescent camps and depots.
Grand total.
Total hospi-
talization
e.s-
8, 300
2,200
17, 400
2,500
17,400
17,800
17,700
17, 700
17,700
8, 300
10, .500
27,900
30, 400
Hospi-
tals
200 119,
100 124,
1221.800
138
7,000
12, om
19,000
8,000
31,000
7,000
31,000
6,000
31,000
5,000
31,000
14,000
183,000
17,000
200,000
13,000
24,000
37,000
14,000
55,000
12,000
55,000
10.000
55,000
8,000
55,000
20,000
321,000
17,000
338, 000
7,000
19,000
13.000
37,000
000 50,000
000 51,000
000 106,000
,000 118,000
,000 173,000
000 183,000
000,238, 000
000 246, 000
000 301,000
14,000 20.000
183.000 321,000
17,000l 17,000
200, 000 338, 000
" 15,000 aviation.
In forwarding this program to the chief surgeon, the adjutant general,
A. E. F., stated that since the whole question of the strength of the American
Expeditionary Forces was dependent upon the amount of tonnage that might
be placed by our Government in the trans-Atlantic transport service, and that
accurate information on this particular subject would not be available for some
time, the commander in chief, A. E. F., was not prepared to take any definite
action beyond such authorization for providing hospitals as had already been
given. The study was believed to be complete enough to warrant consideration
by the chief surgeon with a view of making such recommendations as he desired.
In his analysis of this program, the chief surgeon pointed out that there
were two factors which must be taken into consideration as having a possible
modifying influence on the result arrived at: ^'^ First, the basic principle on
which the program was founded was that the personnel of each base hospital
unit could care for 1,000 patients; second that a base hospital unit in an emer-
gency, could increase its capacity from 1,000 beds to 2,000 beds by the use of
tentage. As to the first, the base hospital unit obviously could not care for 1,000
l)atients if it became necessary to divide the units into small detachments in order
to fit them into small existing buildings which might be taken over from the
French. As to the second factor, the emergency expansion could not be consid-
ered as being possible were existing buildings such as schools and hotels to be taken
over and used as hospitals, in view of the fact that in connection wdth most of
these buildings there was inadequate ground space for expansion. Even if there
were the necessary ground space, the lack of usual hospital facilities, by addi-
tionally burdening the personnel, would almost make expansion out of the
question.
292
ADMINISTRATION, AIVIERICAN EXPEDITIONARY FORCES
On December 15, 1917, the chief surgeon reported to the commander in
chief, A. E. F., that in so far as the Medical Department was concerned, the
project of 73,000 hospital beds along the line of communications iiad be 
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